MEDICARE: SHERAN L. SAMUEL M.A., 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
1	235Z00000X	Speech-Language Pathologist	2213	LA

General Provider Information

NPI Number	:	1871683060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERAN L. SAMUEL M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	7555 SEVENOAKS AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-7648
Country	:	US
Telephone Number	:	225-937-9187
Fax Number	:	225-930-0221

Provider Business Practice Location Address
First Line	:	768 CHEVELLE DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-6503
Country	:	US
Telephone Number	:	225-930-0208
Fax Number	:	225-930-0221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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Directions to “ SHERAN L. SAMUEL M.A., CCC-SLP” Practice Location

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