Provider Demographics
NPI:1972358141
Name:ROZEMA, SAMANTHA GRACE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:GRACE
Last Name:ROZEMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 66TH PL
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-1209
Mailing Address - Country:US
Mailing Address - Phone:847-707-2633
Mailing Address - Fax:
Practice Address - Street 1:5515 66TH PL
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-1209
Practice Address - Country:US
Practice Address - Phone:847-707-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.107725104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker