Provider Demographics
NPI:1346741758
Name:LEIGH, SAMANTHA P (BCBA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:P
Last Name:LEIGH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:P
Other - Last Name:BRETL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5220 6TH STREET FRONTAGE RD E STE 1700
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5771
Mailing Address - Country:US
Mailing Address - Phone:217-525-8332
Mailing Address - Fax:217-789-1420
Practice Address - Street 1:145 SPRINGFIELD CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2495
Practice Address - Country:US
Practice Address - Phone:217-525-8332
Practice Address - Fax:217-789-1420
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-20-41380103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician