Provider Demographics
NPI:1871920124
Name:TUCKER, SAMANTHA ANNE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ANNE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:ANNE
Other - Last Name:SICKELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:3650 HIGHLANDS PKWY SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5184
Mailing Address - Country:US
Mailing Address - Phone:678-305-9200
Mailing Address - Fax:
Practice Address - Street 1:3650 HIGHLANDS PKWY SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5184
Practice Address - Country:US
Practice Address - Phone:678-305-9200
Practice Address - Fax:678-305-9201
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist