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General NPI Number Information
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NPI Number | 1225838360
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Entity Type | Individual
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Provider Name | SAMAH IKRAM MA, LCAT, RDT
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Gender | Female
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 1195 MARCELLA LN
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City | WEST CHICAGO
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State | IL
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Zip | 60185-5061
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Country | US
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Telephone | 510-499-4205
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Fax |
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Provider Business Mailing Address
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Address Line | 787 ROBERT AVE
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City | MADERA
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State | CA
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Zip | 93636-6543
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101200000X
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Taxonomy Name | Drama Therapist
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License Number | 002588
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License Number State | NY
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