MEDICARE: SAMANTHA RAEANNA BUCK

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
1	106S00000X	Behavior Technician
2	106S00000X	Behavior Technician	RBT-21-155526	AZ

General Provider Information

NPI Number	:	1437745429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA RAEANNA BUCK

Provider Business Mailing Address
First Line	:	10969 W LOMA LN
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-0403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5656 S POWER RD STE 115
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-8480
Country	:	US
Telephone Number	:	480-773-4511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	02/05/2022

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Directions to “ SAMANTHA RAEANNA BUCK ” Practice Location

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