Individual
SAMANTHA ROSE FANNIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4327 W MICHIGAN AVE, GLENDALE, AZ 85308-1640
(623) 986-9533
Mailing address
4327 W MICHIGAN AVE, GLENDALE, AZ 85308-1640
(623) 986-9533
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SLPA13538
AZ
Other
Enumeration date
01/03/2022
Last updated
01/03/2022
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