Provider Demographics
NPI:1578826905
Name:DEMBSKI, SAMANTHA JANE (MS,CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JANE
Last Name:DEMBSKI
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 E RIVERSIDE DR
Mailing Address - Street 2:#F-139
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5838
Mailing Address - Country:US
Mailing Address - Phone:408-648-9131
Mailing Address - Fax:
Practice Address - Street 1:827 E. RIVERSIDE DRIVE
Practice Address - Street 2:#F-139
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616
Practice Address - Country:US
Practice Address - Phone:408-648-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16219235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist