Healthcare Provider Details

I. General information

NPI: 1003525296
Provider Name (Legal Business Name): SAMANTHA SCHROLL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 S QUENTIN RD STE 103
PALATINE IL
60067-6778
US

IV. Provider business mailing address

721 S QUENTIN RD STE 103
PALATINE IL
60067-6778
US

V. Phone/Fax

Practice location:
  • Phone: 847-485-7490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.015040
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.016266
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: