Provider Demographics
NPI:1093543233
Name:CAMPOLONGO, SAMANTHA TAYLOR WATTS (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TAYLOR WATTS
Last Name:CAMPOLONGO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:TAYLOR
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 BRINK RD
Mailing Address - Street 2:
Mailing Address - City:CANDOR
Mailing Address - State:NY
Mailing Address - Zip Code:13743-2047
Mailing Address - Country:US
Mailing Address - Phone:203-917-5227
Mailing Address - Fax:
Practice Address - Street 1:4400 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13902-4400
Practice Address - Country:US
Practice Address - Phone:607-777-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist