Provider Demographics
NPI:1740050343
Name:RUDOLF, SAMANTHA BENITA LOUISE (RBT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BENITA LOUISE
Last Name:RUDOLF
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:BENITA LOUISE
Other - Last Name:WESTWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3230 W WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-9609
Mailing Address - Country:US
Mailing Address - Phone:308-381-8851
Mailing Address - Fax:308-381-8853
Practice Address - Street 1:3230 W WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-9609
Practice Address - Country:US
Practice Address - Phone:308-381-8851
Practice Address - Fax:308-381-8853
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician