Provider Demographics
NPI:1992494397
Name:SAWYERS, SAMANTHA MARIE (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:SAWYERS
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14395 SLATEMORE CT
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-3296
Mailing Address - Country:US
Mailing Address - Phone:703-474-4762
Mailing Address - Fax:
Practice Address - Street 1:42382 RISING MOON PL
Practice Address - Street 2:
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148-5703
Practice Address - Country:US
Practice Address - Phone:571-207-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204001110235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty