Provider Demographics
NPI:1487346532
Name:LIDDIL, SAMANTHA JANE (SLPA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:LIDDIL
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-3222
Mailing Address - Country:US
Mailing Address - Phone:206-226-5097
Mailing Address - Fax:
Practice Address - Street 1:702 N GRANITE FALLS AVE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252
Practice Address - Country:US
Practice Address - Phone:360-691-7719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA613707862355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant