Provider Demographics
NPI:1235971029
Name:LOCKENOUR, SAMANTHA ANNE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANNE
Last Name:LOCKENOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:WELSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3636 S WINCHESTER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-1232
Mailing Address - Country:US
Mailing Address - Phone:309-202-6684
Mailing Address - Fax:
Practice Address - Street 1:1200 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-1305
Practice Address - Country:US
Practice Address - Phone:312-548-9051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health