Healthcare Provider Details

I. General information

NPI: 1336809318
Provider Name (Legal Business Name): SAMANTHA MARIE KRAFT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2021
Last Update Date: 07/25/2023
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 W SPENCER ST
APPLETON WI
54914-4308
US

IV. Provider business mailing address

3121 W SPENCER ST
APPLETON WI
54914-4308
US

V. Phone/Fax

Practice location:
  • Phone: 920-385-5051
  • Fax: 202-771-8499
Mailing address:
  • Phone: 920-385-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4898226
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8593125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: