Provider Demographics
NPI:1871930362
Name:SALVATO, SAMANTHA LYN (LPC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYN
Last Name:SALVATO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LYN
Other - Last Name:USTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:12 HEALTH SERVICES DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9637
Mailing Address - Country:US
Mailing Address - Phone:815-756-8501
Mailing Address - Fax:815-756-5849
Practice Address - Street 1:12 HEALTH SERVICES DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9637
Practice Address - Country:US
Practice Address - Phone:815-756-8501
Practice Address - Fax:815-756-5849
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178008825OtherLPC