Healthcare Provider Details

I. General information

NPI: 1306530142
Provider Name (Legal Business Name): SAMANTHA CHAPA APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S 8TH ST STE 240B
SHEBOYGAN WI
53081-4463
US

IV. Provider business mailing address

1520 MAIN AVE
SHEBOYGAN WI
53083-4621
US

V. Phone/Fax

Practice location:
  • Phone: 920-234-6932
  • Fax:
Mailing address:
  • Phone: 920-627-6481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number135012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: