Provider Demographics
NPI:1326569948
Name:JANEGO, SAMANTHA MURDOCK
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MURDOCK
Last Name:JANEGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 CLARENCE ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-2608
Mailing Address - Country:US
Mailing Address - Phone:937-474-9590
Mailing Address - Fax:
Practice Address - Street 1:510 E PEASE AVE
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-1359
Practice Address - Country:US
Practice Address - Phone:937-859-5121
Practice Address - Fax:937-859-5250
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.13055235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty