Provider Demographics
NPI:1326434259
Name:KLEDZIK, SAMANTHA LAUREN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LAUREN
Last Name:KLEDZIK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:LAUREN
Other - Last Name:RICHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401
Mailing Address - Country:US
Mailing Address - Phone:217-500-2103
Mailing Address - Fax:
Practice Address - Street 1:214 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401
Practice Address - Country:US
Practice Address - Phone:217-500-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist