Provider Demographics
NPI:1861947277
Name:JOSEPH, SAMANTHA A (CST)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:A
Other - Last Name:SAWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3099 RIVER RD S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-9754
Mailing Address - Country:US
Mailing Address - Phone:503-361-3094
Mailing Address - Fax:503-485-2168
Practice Address - Street 1:3099 RIVER RD S
Practice Address - Street 2:SUITE 100
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-9754
Practice Address - Country:US
Practice Address - Phone:503-361-3094
Practice Address - Fax:503-485-2168
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR127466246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other