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NPI Code Detail

MEDICARE: SAMANTHA ELIZABETH PERRY

MEDICARE: SAMANTHA ELIZABETH PERRY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149.025570IL
2104100000XSocial Worker150.104616IL

General Provider Information

NPI Number : 1023624160
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA ELIZABETH PERRY
Provider Business Mailing Address
First Line : 25 E WASHINGTON ST STE 1835
Second Line :
City : CHICAGO
State : IL
Zip : 60602-1836
Country : US
Telephone Number : 978-257-1578
Fax Number :
Provider Business Practice Location Address
First Line : 25 E WASHINGTON ST STE 1835
Second Line :
City : CHICAGO
State : IL
Zip : 60602-1836
Country : US
Telephone Number : 312-374-4966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2020
Last Update Date : 04/27/2023

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Directions to “ SAMANTHA ELIZABETH PERRY ” Practice Location

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