Healthcare Provider Details

I. General information

NPI: 1568994994
Provider Name (Legal Business Name): SAMANTHA BAER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7236 S CENTRAL AVE
PHOENIX AZ
85042-5425
US

IV. Provider business mailing address

PO BOX 85073 #47141
RICHMOND VA
23285-5073
US

V. Phone/Fax

Practice location:
  • Phone: 885-772-8847
  • Fax: 248-479-4431
Mailing address:
  • Phone: 305-846-9807
  • Fax: 305-846-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: