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NPI Code Detail

MEDICARE: SAMANTHA RUPPERT MS, BCBA, LBA

MEDICARE: SAMANTHA RUPPERT MS, BCBA, LBA
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
1103K00000XBehavior Analyst1-21-50163IL

General Provider Information

NPI Number : 1184284069
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA RUPPERT MS, BCBA, LBA
Provider Business Mailing Address
First Line : 7228 CIRCLE AVE
Second Line :
City : FOREST PARK
State : IL
Zip : 60130-1163
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7228 CIRCLE AVE
Second Line :
City : FOREST PARK
State : IL
Zip : 60130-1163
Country : US
Telephone Number : 708-665-3642
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2019
Last Update Date : 06/26/2025

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