Individual
SAMANTHA LYNN GODFREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2555 COUNTY ROAD E E # 102, WHITE BEAR LAKE, MN 55110-4906
(651) 683-2953
Mailing address
2555 COUNTY ROAD E E # 102, WHITE BEAR LAKE, MN 55110-4906
(651) 683-2953
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-8783348
ADVANCE SPEECH THERAPY, LLC
—
Enumeration date
09/04/2018
Last updated
09/04/2018
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