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NPI Code Detail

MEDICARE: SAMANTHA CANTRELL

MEDICARE: SAMANTHA CANTRELL
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1295447159
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA CANTRELL
Provider Business Mailing Address
First Line : 6621 N PONCHARTRAIN BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60646-1427
Country : US
Telephone Number : 773-750-4273
Fax Number :
Provider Business Practice Location Address
First Line : 7215 WESTSHIRE DR STE 200
Second Line :
City : LANSING
State : MI
Zip : 48917-9764
Country : US
Telephone Number : 248-221-2975
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2022
Last Update Date : 01/11/2024

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Directions to “ SAMANTHA CANTRELL ” Practice Location

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