SAMANTHA BLACK
Speech-Language Pathologist

Address: 1510 E 55th St, Chicago, IL 60615-2598

SAMANTHA BLACK (NPI# 1104416700) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1104416700
Entity Type Individual
Full Name SAMANTHA BLACK
Gender Female
Credential MA CCC-SLP/L
Practice Address 1510 E 55th St
Chicago
IL 60615-2598
Practice Telephone 2193638498
Mailing Address 821 W Newport Ave Apt 3f
Chicago
IL 60657-2354
Mailing Telephone 3129954681
Certification Date 2020-12-31
Enumeration Date 2021-01-19
Last Update Date 2021-01-19
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification Taxonomy Group License Number License State Taxonomy Group
Y 235Z00000X Speech-Language Pathologist 146.015549 IL Speech, Language and Hearing Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
IL 1619340874 MEDICAID

Associated Endpoints

Endpoint Type Endpoint Affiliation Affiliation Address Use Content
Other URL Chicago 1510 E 55th St, Chicago, IL 606152598 Health Information Exchange (HIE)

Other providers with the same name

NPI Name Taxonomy Address Enumeration
1740684448 Samantha Black 310 Ne Flanders, Portland, OR 97209 2014-10-09
1366851883 Samantha Black 112b Bypass 225, Greenwood, SC 29646-1154 2014-08-08
1073885315 Samantha Black 267 44th St Fl 2, Brooklyn, NY 11232-2815 2012-02-02

Office Location

Street Address 1510 E 55TH ST
City CHICAGO
State IL
Zip Code 60615-2598

Providers in the same zip code prefix

NPI Name Taxonomy Address Enumeration
1568053635 Jalen Cobb Counselor · Professional 5128 S Michigan, Chicago, IL 60615 2021-02-01
1578170221 Cook County · Provident Dialysis Center Technician, Other · Renal Dialysis 430 East 51st Pl, Chicago, IL 60615 2020-09-28
1700498326 Connie Frances Davis Massage Therapist 5481 S. Cornell, Chicago, IL 60615 2020-08-17
1134781974 Lifestyle Rejuvenation Medical Group Pllc Chiropractor 1740 E 55th Street, Chicago, IL 60615 2019-07-02
1275007767 Michelle Alyse Costello Social Worker · Clinical 1225 E 53rd St, Suite 606, Chicago, IL 60615 2019-01-17
1194207522 Cindy Louise Lys Social Worker · Clinical 1525 E 53rd Street Suite 516-4, Chicago, IL 60615 2018-09-01
1861983660 Pranusha Pinna Student in an Organized Health Care Education/Training Program 1850 W. Harrison St., Chicago, IL 60615 2018-05-29
1528577632 Jonah Waseberg Counselor · Mental Health 1100 E.55th St, Chicago, IL 60615 2017-09-21
1710404496 Tawann Jackson Psychologist · School 360 Blair Lane, Door 13, Bolingbrook, IL 60615 2017-08-24
1194259069 Molly Kachale Netter Nurse Practitioner · Primary Care 1554 E 55th St., Chicago, IL 60615 2017-04-17
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Taxonomy Information

Taxonomy Code 235Z00000X
Grouping Speech, Language and Hearing Service Providers
Classification Speech-Language Pathologist

Taxonomy Definition

The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.
Notes: "Scope of Practice in Speech-Language Pathology", American Speech-Language-Hearing Association, 2013.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1831781525 Iliana Roman 6215 S Kolmar Ave, Chicago, IL 60629-5435 2021-02-04
1578154597 Verboso LLC 203 N. Lasalle St., Suite 2100, Chicago, IL 60601 2021-02-02
1568052736 Mary June O'Connell 2734 W 107th St, Chicago, IL 60655-1736 2021-01-21
1295324507 Elana Shira Hunt 2343 W Iowa St Apt 1s, Chicago, IL 60622-0197 2021-01-12
1912501917 Catherine Margaret Pinas 1424 W Division St Apt 4, Chicago, IL 60642-3360 2020-11-30
1346843356 Colleen Frost 10753 S Ridgeway Ave, Chicago, IL 60655-3902 2020-11-20
1780285429 Lily Heine 1425 W Albion Ave Apt 3, Chicago, IL 60626-5022 2020-11-07
1164022588 Mary Kate Zagotta 555 W Kinzie St Apt 1608, Chicago, IL 60654-5847 2020-10-26
1134727134 Madison Frazier 1221 N Dearborn St Apt 1206n, Chicago, IL 60610-8377 2020-10-12
1336746809 Karen M Olson 4506 N Ashland Ave Apt 1s, Chicago, IL 60640-5445 2020-10-07
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Competitor

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City CHICAGO
Zip Code 60615

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.