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General NPI Number Information
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NPI Number | 1821361882
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Entity Type | Individual
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Provider Name | SAMUEL M SABAKA PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 11/14/2012
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Provider Practice Location Address
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Address Line | 29755 BROADWAY ST
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City | LINDSTROM
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State | MN
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Zip | 55045-9386
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Country | US
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Telephone | 770-324-8647
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Fax |
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Provider Business Mailing Address
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Address Line | 29755 BROADWAY ST
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City | LINDSTROM
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State | MN
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Zip | 55045-9386
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Country | US
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Telephone | 770-324-8647
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 003491
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5536
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License Number State | MN
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