Provider Demographics
NPI:1316234396
Name:PAGANO, SAMANTHA E (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:E
Last Name:PAGANO
Suffix:
Gender:F
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 1:11 SHEPHERDS LN
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6123
Mailing Address - Country:US
Mailing Address - Phone:215-630-2778
Mailing Address - Fax:
Practice Address - Street 1:11 SHEPHERDS LN
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6123
Practice Address - Country:US
Practice Address - Phone:215-630-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010185235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist