MEDICARE: SAMANTHA SCHLEDEWITZ BCABA

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	0-14-6189

General Provider Information

NPI Number	:	1932580339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA SCHLEDEWITZ BCABA

Provider Business Mailing Address
First Line	:	1130 OLD MILL LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-1256
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 OLD MILL LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-1256
Country	:	US
Telephone Number	:	317-334-7331
Fax Number	:

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

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	06/11/2015

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