Individual
MRS. SAMANTHA FORDHAM DEPUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED. CCC-SLP, BCBA
Contact information
Practice address
6329 BROOKSTONE BLVD, COLUMBUS, GA 31904-2993
(706) 577-3942
(706) 287-1057
Mailing address
6329 BROOKSTONE BLVD, COLUMBUS, GA 31904-2993
(706) 577-3942
(706) 287-1057
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-22-62671
—
235Z00000X
Speech-Language Pathologist
Primary
SLP6138
GA
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-22-62671
BEHAVIOR ANALYST CERTIFICATION BOARD
—
01
—
SLP 6138
GA LICENSE
GA
Enumeration date
03/19/2007
Last updated
06/27/2025
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