Healthcare Provider Details

I. General information

NPI: 1861965428
Provider Name (Legal Business Name): SAMANTHA ANNE RICHARDS MSW, APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 8TH ST
BARABOO WI
53913-1794
US

IV. Provider business mailing address

727 8TH ST
BARABOO WI
53913-1794
US

V. Phone/Fax

Practice location:
  • Phone: 608-220-4256
  • Fax:
Mailing address:
  • Phone: 608-220-4256
  • Fax: 608-355-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: