MEDICARE: SAMANTHA JENKINS

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		IN

General Provider Information

NPI Number	:	1578427068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA JENKINS

Provider Business Mailing Address
First Line	:	30 TIMRICK DR
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-2150
Country	:	US
Telephone Number	:	773-762-9886
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 W FRANCISCAN DR
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-4802
Country	:	US
Telephone Number	:	888-998-5269
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ SAMANTHA JENKINS ” Practice Location

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