Healthcare Provider Details

I. General information

NPI: 1821907395
Provider Name (Legal Business Name): SAMANTHA ANN GASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15255 S HARLEM AVE
ORLAND PARK IL
60462-4329
US

IV. Provider business mailing address

8534 S KNOX AVE
CHICAGO IL
60652-3521
US

V. Phone/Fax

Practice location:
  • Phone: 708-226-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.018662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: