Healthcare Provider Details

I. General information

NPI: 1144097999
Provider Name (Legal Business Name): SOMA & SAGE INTEGRATIVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 CLEVELAND AVE N STE 222
SAINT PAUL MN
55104-5589
US

IV. Provider business mailing address

1965 FIELD AVE
SAINT PAUL MN
55116-2604
US

V. Phone/Fax

Practice location:
  • Phone: 612-208-3706
  • Fax: 833-450-3706
Mailing address:
  • Phone: 651-334-4631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURIE GEDDES
Title or Position: NURSE PRACTITIONER/OWNER
Credential: APRN, CNP
Phone: 651-334-4631