MEDICARE: SAMANTHA EDEN THOMPSON MSW, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	23182	MN

General Provider Information

NPI Number	:	1952234114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA EDEN THOMPSON MSW, LICSW

Provider Business Mailing Address
First Line	:	7218 384TH ST
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-5801
Country	:	US
Telephone Number	:	651-279-1731
Fax Number	:

Provider Business Practice Location Address
First Line	:	7218 384TH ST
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-5801
Country	:	US
Telephone Number	:	651-279-1731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2026
Last Update Date	:	06/06/2026

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