Healthcare Provider Details

I. General information

NPI: 1821661380
Provider Name (Legal Business Name): SAMANTHA BUHAI-JACOBUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 N KINGSBURY ST STE 303
CHICAGO IL
60642-2687
US

IV. Provider business mailing address

1333 N KINGSBURY ST STE 303
CHICAGO IL
60642-2687
US

V. Phone/Fax

Practice location:
  • Phone: 312-809-0298
  • Fax:
Mailing address:
  • Phone: 312-809-0298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: