Provider Demographics
NPI:1336959576
Name:TREVINO, SAMANTHA (HIS)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:TREVINO
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2608
Mailing Address - Country:US
Mailing Address - Phone:773-733-9995
Mailing Address - Fax:
Practice Address - Street 1:9500 JOLIET RD
Practice Address - Street 2:
Practice Address - City:HODGKINS
Practice Address - State:IL
Practice Address - Zip Code:60525-4137
Practice Address - Country:US
Practice Address - Phone:708-485-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3567237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist