Healthcare Provider Details

I. General information

NPI: 1689504573
Provider Name (Legal Business Name): SAMANTHA ADAMS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 4TH ST
ORION IL
61273-7731
US

IV. Provider business mailing address

720 E CULVER CT
GENESEO IL
61254-1851
US

V. Phone/Fax

Practice location:
  • Phone: 563-279-2005
  • Fax:
Mailing address:
  • Phone: 563-279-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: