Provider Demographics
NPI:1124803929
Name:SEYMOUR, SAMANTHA (CF, SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:CF, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 S HOLLY CIR STE 295
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1076
Mailing Address - Country:US
Mailing Address - Phone:720-542-8737
Mailing Address - Fax:
Practice Address - Street 1:6851 S HOLLY CIR STE 295
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1076
Practice Address - Country:US
Practice Address - Phone:720-542-8737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0001188235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist