Provider Demographics
NPI:1538544150
Name:SAMUSEVICH, ALINA
Entity type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:SAMUSEVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 OSPREY DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-4474
Mailing Address - Country:US
Mailing Address - Phone:917-348-2555
Mailing Address - Fax:
Practice Address - Street 1:1016 OSPREY DR
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-4474
Practice Address - Country:US
Practice Address - Phone:917-348-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117834235Z00000X
NY025927235Z00000X
235Z00000X
GASLP012764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist