Healthcare Provider Details

I. General information

NPI: 1710767611
Provider Name (Legal Business Name): SAMANTHA JAHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6017 WASHINGTON AVE
OCEAN SPRINGS MS
39564-2648
US

IV. Provider business mailing address

296 BEAUVOIR RD STE 100-1311
BILOXI MS
39531-4051
US

V. Phone/Fax

Practice location:
  • Phone: 228-707-4417
  • Fax:
Mailing address:
  • Phone: 228-707-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number262000
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: