Provider Demographics
NPI:1871103689
Name:WEISS, SAMANTHA (MA)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 OLD DUBLIN RD UNIT 235
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-2090
Mailing Address - Country:US
Mailing Address - Phone:513-237-9437
Mailing Address - Fax:
Practice Address - Street 1:2840 E ORANGE RD
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9300
Practice Address - Country:US
Practice Address - Phone:513-237-9437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20201295-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist