Provider Demographics
NPI:1114773983
Name:KLEIN-VIDRINE, SAMANTHA LEE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEE
Last Name:KLEIN-VIDRINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX C
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70655-2003
Mailing Address - Country:US
Mailing Address - Phone:337-639-4311
Mailing Address - Fax:337-639-2346
Practice Address - Street 1:412 N 12TH ST
Practice Address - Street 2:
Practice Address - City:KINDER
Practice Address - State:LA
Practice Address - Zip Code:70648-3311
Practice Address - Country:US
Practice Address - Phone:337-738-2454
Practice Address - Fax:337-738-5526
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA93692355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant