Provider Demographics
NPI:1962139188
Name:JENNINGS, SAMANTHA RAE (MA-SLP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:RAE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MA-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 N BURNS AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-2626
Mailing Address - Country:US
Mailing Address - Phone:620-655-2233
Mailing Address - Fax:
Practice Address - Street 1:3001 IVY DR
Practice Address - Street 2:
Practice Address - City:NORTH NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67117-8001
Practice Address - Country:US
Practice Address - Phone:316-284-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3815235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty