MEDICARE: SAMANTHA WEEMAN M. ED, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-22-63313	AZ

General Provider Information

NPI Number	:	1396503942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA WEEMAN M. ED, BCBA

Provider Business Mailing Address
First Line	:	4282 E AGAVE RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-4621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4282 E AGAVE RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-4621
Country	:	US
Telephone Number	:	480-287-3440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2024
Last Update Date	:	03/08/2024

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