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NPI Code Detail

MEDICARE: SAMANTHA L CHAULKLIN BCBA

MEDICARE: SAMANTHA L CHAULKLIN BCBA
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
1103K00000XBehavior AnalystWI

General Provider Information

NPI Number : 1871229740
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA L CHAULKLIN BCBA
Provider Business Mailing Address
First Line : 1020 W HISTORIC MITCHELL ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53204-3307
Country : US
Telephone Number : 414-520-7069
Fax Number :
Provider Business Practice Location Address
First Line : 1020 W HISTORIC MITCHELL ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53204-3307
Country : US
Telephone Number : 414-520-7069
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2022
Last Update Date : 07/25/2022

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