Provider Demographics
NPI:1285995225
Name:TAFT, SAMANTHA I (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:I
Last Name:TAFT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LELAND ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1414
Mailing Address - Country:US
Mailing Address - Phone:508-612-2232
Mailing Address - Fax:
Practice Address - Street 1:72 JEFFERSON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1259
Practice Address - Country:US
Practice Address - Phone:508-485-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8210235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist