Healthcare Provider Details

I. General information

NPI: 1619121571
Provider Name (Legal Business Name): SAMANTHA BAUER ZYLSTRA MS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S WEBSTER ST STE 230
NAPERVILLE IL
60540-5356
US

IV. Provider business mailing address

29 S WEBSTER ST STE 230
NAPERVILLE IL
60540-5356
US

V. Phone/Fax

Practice location:
  • Phone: 415-585-3132
  • Fax:
Mailing address:
  • Phone: 415-585-3132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number44677
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0001997
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.000962
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: