Provider Demographics
NPI:1437580560
Name:BUTLER, SAMANTHA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:DUNDEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:865 E WILMETTE RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-6493
Mailing Address - Country:US
Mailing Address - Phone:224-210-0669
Mailing Address - Fax:
Practice Address - Street 1:865 E WILMETTE RD
Practice Address - Street 2:SUITE G
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-6493
Practice Address - Country:US
Practice Address - Phone:224-210-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL11314287103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst