Provider Demographics
NPI:1619406212
Name:LYNCH, SAMANTHA (SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:LYNCH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CHESTER HAHN RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40008-7014
Mailing Address - Country:US
Mailing Address - Phone:862-268-6139
Mailing Address - Fax:
Practice Address - Street 1:202 W STEPHEN FOSTER AVE STE A
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1466
Practice Address - Country:US
Practice Address - Phone:502-233-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100474650Medicaid