Healthcare Provider Details

I. General information

NPI: 1952234114
Provider Name (Legal Business Name): SAMANTHA EDEN THOMPSON MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

7218 384TH ST
NORTH BRANCH MN
55056-5801
US

IV. Provider business mailing address

7218 384TH ST
NORTH BRANCH MN
55056-5801
US

V. Phone/Fax

Practice location:
  • Phone: 651-279-1731
  • Fax:
Mailing address:
  • Phone: 651-279-1731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23182
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: