Healthcare Provider Details

I. General information

NPI: 1790483733
Provider Name (Legal Business Name): SAMUEL JOHN DEGEEST LICSW, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0002
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0002
US

V. Phone/Fax

Practice location:
  • Phone: 507-422-4444
  • Fax: 507-255-8498
Mailing address:
  • Phone: 507-422-4444
  • Fax: 507-255-8498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25767
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26139
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: