Healthcare Provider Details

I. General information

NPI: 1356267298
Provider Name (Legal Business Name): SAMANTHA LEIGH BAER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 METRO BLVD STE 505
EDINA MN
55439-3018
US

IV. Provider business mailing address

5708 CAMBRIDGE ST
SAINT LOUIS PARK MN
55416-5113
US

V. Phone/Fax

Practice location:
  • Phone: 651-271-1665
  • Fax:
Mailing address:
  • Phone: 612-965-4927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4942
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: