Healthcare Provider Details

I. General information

NPI: 1497315188
Provider Name (Legal Business Name): SAMANTHA DANNLEY HIRSCHEY MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2019
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 94TH AVE N
BROOKLYN PARK MN
55443-1992
US

IV. Provider business mailing address

5500 94TH AVE N
BROOKLYN PARK MN
55443-1992
US

V. Phone/Fax

Practice location:
  • Phone: 763-762-6800
  • Fax:
Mailing address:
  • Phone: 763-762-8810
  • Fax: 763-315-6685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25502
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: