Most Relevant Information
Provider Data
| NPI Number: | 1003338104 |
| Provider Name: | SAMANTHA LYNN HAIDEN BHS, ATC, LAT |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: | AT7197 |
Most Important Dates
| Enumeration Date: | 07/10/2017 |
| Last Updated: | 07/21/2022 |
Provider Practice Location
2N150 DIANE AVE
GLEN ELLYN
IL
601373138
Practice Location Phone/Fax
| Phone: | 6302971120 |
| Fax: |
Provider Mailing Location
2N150 DIANE AVE
GLEN ELLYN
IL
601373138
Provider Mailing Phone/Fax
| Phone: | 6302971120 |
| Fax: |