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NPI Code Detail

MEDICARE: SAMANTHA MARIE ESPINOSA

MEDICARE: SAMANTHA MARIE ESPINOSA
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
1390200000XStudent in an Organized Health Care Education/Training Program
2101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1306596986
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA MARIE ESPINOSA
Provider Business Mailing Address
First Line : 3632 N ODELL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60634-3422
Country : US
Telephone Number : 224-558-0068
Fax Number :
Provider Business Practice Location Address
First Line : 501 DAVIS ST
Second Line :
City : EVANSTON
State : IL
Zip : 60201-4619
Country : US
Telephone Number : 312-546-4193
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2022
Last Update Date : 04/19/2022

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Directions to “ SAMANTHA MARIE ESPINOSA ” Practice Location

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