Individual
SAMANTHA RENEE MINICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
5154 N PARK AVE, INDIANAPOLIS, IN 46205-1066
(260) 223-5350
Mailing address
5154 N PARK AVE, INDIANAPOLIS, IN 46205-1066
(260) 223-5350
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22008951A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7928
SOUTH CAROLINA SLP LICENSE
SC
Enumeration date
07/12/2019
Last updated
12/24/2024
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