Individual
MS. SAMANTHA BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
650 W GRAND AVE STE 270, ELMHURST, IL 60126-1043
(244) 263-1613
Mailing address
182 GOLDENEYE LN, BLOOMINGDALE, IL 60108-5404
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-17-29693
—
103K00000X
Behavior Analyst
Primary
1-18-29693
—
Other
Enumeration date
03/26/2018
Last updated
05/04/2018
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