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General NPI Number Information
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NPI Number | 1679928253
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Entity Type | Organization
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Legal Business Name | SAMANTHA ZYLSTRA
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 50 S MAIN ST
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City | NAPERVILLE
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State | IL
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Zip | 60540-5484
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Country | US
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Telephone | 415-585-3132
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Fax |
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Provider Business Mailing Address
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Address Line | 50 S MAIN ST
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City | NAPERVILLE
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State | IL
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Zip | 60540-5484
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Country | US
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Telephone | 415-585-3132
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SAMANTHA ZYLSTRA
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Credential | MS
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Telephone | 415-585-3132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 44677
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.000962
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License Number State | IL
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