Provider Demographics
NPI:1023770401
Name:GLICKMAN, SAMANTHA L (MS)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:GLICKMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W REMINGTON LN APT 104
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3664
Mailing Address - Country:US
Mailing Address - Phone:847-942-1087
Mailing Address - Fax:
Practice Address - Street 1:8235 LINDER AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2066
Practice Address - Country:US
Practice Address - Phone:708-499-0838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.006512235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist