Provider Demographics
NPI:1588540801
Name:SAMANIEGO, SERENA ALANA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:ALANA
Last Name:SAMANIEGO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14901 NIGHTMIST RD
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-2051
Mailing Address - Country:US
Mailing Address - Phone:817-247-7696
Mailing Address - Fax:
Practice Address - Street 1:7060 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7119
Practice Address - Country:US
Practice Address - Phone:817-814-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122851235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist