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Organization
SANTA ROSA SPEECH & LANGUAGE SERVICES
Active
Organization
SANTA ROSA SPEECH & LANGUAGE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN MAR SAMPLES PHD (OWNER)
(707) 542-1010
Entity
Organization
Contact information
Practice address
4725B HOEN AVE, SANTA ROSA, CA 95405-7862
(707) 542-1010
(707) 542-4818
Mailing address
4725B HOEN AVE, SANTA ROSA, CA 95405-7862
(707) 542-1010
(707) 542-4818
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP1429
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ77845Z
—
CA
Enumeration date
12/16/2005
Last updated
07/01/2008
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