MEDICARE: SAMANTHA ANDERSON

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	103K00000X	Behavior Analyst	1-23-64489	IL

General Provider Information

NPI Number	:	1447950779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ANDERSON

Provider Business Mailing Address
First Line	:	3647 N NOTTINGHAM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2243
Country	:	US
Telephone Number	:	773-677-6726
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 LEXINGTON DR
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-6929
Country	:	US
Telephone Number	:	224-676-0202
Fax Number	:

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

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	03/06/2023

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Directions to “ SAMANTHA ANDERSON ” Practice Location

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