Provider Demographics
NPI:1952883282
Name:ROUETTE, SAMANTHA
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:ROUETTE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:ACEVEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3075 N AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60083-9283
Mailing Address - Country:US
Mailing Address - Phone:847-804-6801
Mailing Address - Fax:
Practice Address - Street 1:3075 N AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:IL
Practice Address - Zip Code:60083-9283
Practice Address - Country:US
Practice Address - Phone:847-804-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0232161041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker