Individual
SAMANTHA TENNYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3023 S FORT AVE STE B, SPRINGFIELD, MO 65807-4217
(417) 890-4656
Mailing address
3023 S FORT AVE STE B, SPRINGFIELD, MO 65807-4217
(417) 890-4656
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2021034057
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021034057
MISSOURI SLP LICENSE
MO
Enumeration date
08/23/2021
Last updated
08/23/2021
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