Individual
MARY SAMPLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
904 KING AVE, PORTAGEVILLE, MO 63873-1378
(573) 379-5706
(573) 379-5873
Mailing address
1680 HWY 61, PORTAGEVILLE, MO 63873
(573) 379-0357
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
107513
MO
235Z00000X
Speech-Language Pathologist
2057
AR
Other
Enumeration date
08/19/2006
Last updated
10/29/2009
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