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Individual
SAMANTHA SHAFFER
Active
Individual
SAMANTHA SHAFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB484571
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BACB484571
RBT
—
Enumeration date
03/11/2019
Last updated
03/11/2019
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