Individual
SAMANTHA CARROL WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1824 COMMONS CIR STE B, YUKON, OK 73099-9538
(405) 467-6782
Mailing address
1824 COMMONS CIR STE B, YUKON, OK 73099-9538
(405) 467-6782
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3751
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497178156
—
OK
Enumeration date
08/24/2022
Last updated
08/24/2022
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