Provider Demographics
NPI:1871093138
Name:EWING, SAMANTHA (AUD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:EWING
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 SUMMIT BLVD.
Mailing Address - Street 2:# 204
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021
Mailing Address - Country:US
Mailing Address - Phone:720-401-2139
Mailing Address - Fax:303-469-4439
Practice Address - Street 1:403 SUMMIT BLVD.
Practice Address - Street 2:# 204
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021
Practice Address - Country:US
Practice Address - Phone:720-401-2139
Practice Address - Fax:303-469-4439
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD.0000860231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist