Individual
SAMANTHA NEEDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
3130 CHATHAM RD STE A, SPRINGFIELD, IL 62704
(847) 807-3717
Mailing address
5 REVERE DR STE 120, NORTHBROOK, IL 60062-8005
(847) 807-3717
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-35092
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
02/07/2018
Last updated
04/01/2022
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