Healthcare Provider Details

I. General information

NPI: 1841106127
Provider Name (Legal Business Name): SAMANTHA GERRING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 W 1ST ST
WACONIA MN
55387-1302
US

IV. Provider business mailing address

2101 WOODDALE DR STE B
WOODBURY MN
55125-4442
US

V. Phone/Fax

Practice location:
  • Phone: 651-734-9633
  • Fax: 651-734-9533
Mailing address:
  • Phone: 651-734-9633
  • Fax: 651-734-9533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number304980
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: