MEDICARE: CATHERINE SAMB LPC

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	101YP2500X	Professional Counselor	2908125	WI

General Provider Information

NPI Number	:	1770777898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE SAMB LPC

Provider Business Mailing Address
First Line	:	3530 N CTY TRK HWY F
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53547-1649
Country	:	US
Telephone Number	:	608-757-5281
Fax Number	:	608-758-8418

Provider Business Practice Location Address
First Line	:	3530 N CTY TRK HWY F
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53547-1649
Country	:	US
Telephone Number	:	608-757-5281
Fax Number	:	608-758-8418

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	08/31/2007

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