Provider Demographics
NPI:1871053561
Name:WESTRICH, SAMANTHA M
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:WESTRICH
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 1:2801 MAIL SERVICE CTR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27699-2801
Mailing Address - Country:US
Mailing Address - Phone:919-855-3564
Mailing Address - Fax:919-715-1050
Practice Address - Street 1:4900 WATERS EDGE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2463
Practice Address - Country:US
Practice Address - Phone:919-859-8361
Practice Address - Fax:336-419-2755
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13480235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist