Samantha Bundy, LCSW
Individual provider Active NPI Clinical Social Worker · Chatham, IL
NPI 1093218976 · NPPES record last updated Mar 16, 2018
Key facts
- NPI
- 1093218976
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149018490 (IL)
- Practice address
- 101 E Plummer Blvd
Chatham, IL 62629-8047 - Phone
- (217) 483-3487
- Fax
- (217) 483-8150
- NPI assigned
- Mar 16, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149018490 | IL | Yes |
Addresses
Primary practice location
101 E Plummer Blvd
Chatham, IL 62629-8047
Mailing address
PO Box 3428
Springfield, IL 62708-3428
Phone (217) 588-2624
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149018490 | Other | IL | LCSW LICENSE |
Other providers in Chatham, IL
- Rebecca Boyd
- Christina Ann Brewer
- William E. Brewer
- Brian McNeil, Inc
- Broadstep Academy-Illinois Inc
- Maria Katrina Caga-Anan
- Chatham Fire Protection District
- Chatham Presbyterian Church
- Erin L Collinsworth
- Jean Corriveau
All providers in Chatham, IL · Clinical Social Worker in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.