Provider Demographics
NPI:1801640529
Name:CLABAUGH, SAMUEL S (HIS)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:S
Last Name:CLABAUGH
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 45TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3958
Mailing Address - Country:US
Mailing Address - Phone:219-934-9396
Mailing Address - Fax:219-924-7899
Practice Address - Street 1:1950 45TH ST STE 205
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3958
Practice Address - Country:US
Practice Address - Phone:219-934-9396
Practice Address - Fax:219-924-7899
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001429A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist