Provider Demographics
NPI:1487168985
Name:HOM, SAMANTHA JILLIAN (MS)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JILLIAN
Last Name:HOM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 KENMARE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4618
Mailing Address - Country:US
Mailing Address - Phone:508-523-2746
Mailing Address - Fax:
Practice Address - Street 1:52 KENMARE ST APT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4618
Practice Address - Country:US
Practice Address - Phone:508-523-2746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist