Provider Demographics
NPI:1316419922
Name:QUINN, SAMANTHA LEIGH
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:QUINN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:LEIGH
Other - Last Name:MANWILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:418 CHAMPS LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-3118
Mailing Address - Country:US
Mailing Address - Phone:302-985-1740
Mailing Address - Fax:
Practice Address - Street 1:201 BOOTH ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5618
Practice Address - Country:US
Practice Address - Phone:410-996-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07377235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist