MEDICARE: SAMANTHA DOUGLASS

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1891643144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA DOUGLASS

Provider Business Mailing Address
First Line	:	322 N 2200 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-2922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 N 2200 W
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-2922
Country	:	US
Telephone Number	:	800-469-7423
Fax Number	:

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

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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Directions to “ SAMANTHA DOUGLASS ” Practice Location

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