Individual
SAMANTHA KODER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12 HEALTH SERVICES DR, DEKALB, IL 60115-9637
(815) 756-4875
Mailing address
PO BOX 1109, DEKALB, IL 60115-7109
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150.107957
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
474579189001
—
IL
Enumeration date
07/14/2021
Last updated
06/01/2022
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