Individual
SAMANTHA WHITING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
954 EASTPORT CENTRE DR STE B, VALPARAISO, IN 46383-4456
(630) 408-7372
Mailing address
106 ARDMORE AVE, LA PORTE, IN 46350-2068
(630) 408-7372
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
33009296A
IN
106S00000X
Behavior Technician
—
—
Other
Enumeration date
06/21/2017
Last updated
08/01/2019
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