Provider Demographics
NPI:1285067306
Name:EVERHART, SAMANTHA (PHD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:EVERHART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:ANN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:13800 W NORTH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4977
Mailing Address - Country:US
Mailing Address - Phone:262-432-6600
Mailing Address - Fax:262-432-6604
Practice Address - Street 1:13800 W NORTH AVE STE 120
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4977
Practice Address - Country:US
Practice Address - Phone:262-432-6600
Practice Address - Fax:262-432-6604
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5002103TC0700X, 103TC2200X
CAPSY32901103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty