Individual
SAMANTHA JEAN FORSYTHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10717 VIRGINIA PLZ STE 113, LA VISTA, NE 68128-3255
(402) 926-4373
Mailing address
1214 APPLEWOOD DR APT F206, PAPILLION, NE 68046-7631
(314) 504-9878
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-367940
NE
Other
Enumeration date
08/14/2024
Last updated
08/14/2024
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