Provider Demographics
NPI:1588123558
Name:LENNOX, SAMANTHA JO (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:LENNOX
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JO
Other - Last Name:CLEMENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:56954 240TH ST
Mailing Address - Street 2:
Mailing Address - City:ALBERTA
Mailing Address - State:MN
Mailing Address - Zip Code:56207-4651
Mailing Address - Country:US
Mailing Address - Phone:320-413-0203
Mailing Address - Fax:
Practice Address - Street 1:1100 COURT DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-4722
Practice Address - Country:US
Practice Address - Phone:320-585-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist