Provider Demographics
NPI:1174531180
Name:WAMPLER, SAMANTHA RATLIFF (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:RATLIFF
Last Name:WAMPLER
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CLUB POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-5572
Mailing Address - Country:US
Mailing Address - Phone:423-323-5557
Mailing Address - Fax:
Practice Address - Street 1:103 NORTH ST
Practice Address - Street 2:SUITE B BRISTOL REGIONAL SPEECH & HEARING CENTER
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3201
Practice Address - Country:US
Practice Address - Phone:276-669-6331
Practice Address - Fax:276-669-2950
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
137815OtherANTHEM