Healthcare Provider Details

I. General information

NPI: 1033729785
Provider Name (Legal Business Name): MS. SAMANTHA JO FLOERSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11410 NE 122ND WAY STE 100
KIRKLAND WA
98034-6927
US

IV. Provider business mailing address

11410 NE 122ND WAY STE 100
KIRKLAND WA
98034-6927
US

V. Phone/Fax

Practice location:
  • Phone: 425-650-4005
  • Fax:
Mailing address:
  • Phone: 425-650-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305771
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP61210985
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number70151477
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: