Healthcare Provider Details

I. General information

NPI: 1457290223
Provider Name (Legal Business Name): SAMANTHA POUNDS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 W SAINT GERMAIN ST
SAINT CLOUD MN
56301-6280
US

IV. Provider business mailing address

22662 207TH ST
BECKER MN
55308-9136
US

V. Phone/Fax

Practice location:
  • Phone: 320-259-4151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLICC4264
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: