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NPI Code Detail

MEDICARE: SARAH CHRISTINE SAMUELSON MS/CCC-SLP

MEDICARE: SARAH CHRISTINE SAMUELSON MS/CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist2072154WI

General Provider Information

NPI Number : 1619981180
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH CHRISTINE SAMUELSON MS/CCC-SLP
Provider Business Mailing Address
First Line : 1223 MADISON ST
Second Line :
City : BEAVER DAM
State : WI
Zip : 53916-2629
Country : US
Telephone Number : 920-885-4750
Fax Number :
Provider Business Practice Location Address
First Line : 1223 MADISON ST
Second Line :
City : BEAVER DAM
State : WI
Zip : 53916-2629
Country : US
Telephone Number : 920-885-4750
Fax Number : 920-885-3839
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 07/08/2007

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Directions to “ SARAH CHRISTINE SAMUELSON MS/CCC-SLP” Practice Location

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