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General NPI Number Information
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NPI Number | 1518771237
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Entity Type | Individual
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Provider Name | KAYLA NICHOLE SAMUELS
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Gender | Female
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 332 S MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60604-4434
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Country | US
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Telephone | 773-658-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 8049 S CONSTANCE AVE
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City | CHICAGO
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State | IL
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Zip | 60617-1028
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Country | US
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Telephone | 773-658-7210
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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