Provider Demographics
NPI:1538417555
Name:WEATHERFORD, SAMANTHA LYNN (MS, CF-SLP)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:LYNN
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 N HARRISON ST
Mailing Address - Street 2:APT 4
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4648
Mailing Address - Country:US
Mailing Address - Phone:636-395-1099
Mailing Address - Fax:
Practice Address - Street 1:61 CORPORATE CIR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2439
Practice Address - Country:US
Practice Address - Phone:302-324-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO4-0000352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist