Provider Demographics
NPI:1194300202
Name:ZEPIK, SAMUEL GORDON (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GORDON
Last Name:ZEPIK
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 RIVER CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MI
Mailing Address - Zip Code:49419-9702
Mailing Address - Country:US
Mailing Address - Phone:616-566-8520
Mailing Address - Fax:
Practice Address - Street 1:3740 VISTA SPRINGS AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-2463
Practice Address - Country:US
Practice Address - Phone:616-566-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101006625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist