Provider Demographics
NPI:1275311524
Name:NUSINOW KOLKO, SAMANTHA KERRY (MSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KERRY
Last Name:NUSINOW KOLKO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 PARTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3634
Mailing Address - Country:US
Mailing Address - Phone:847-845-2841
Mailing Address - Fax:
Practice Address - Street 1:707 LAKE COOK RD STE 105
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4909
Practice Address - Country:US
Practice Address - Phone:866-220-8371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program