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General NPI Number Information
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NPI Number | 1033841747
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Entity Type | Individual
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Provider Name | SAMANTHA LEE MA
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Gender | Female
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 7520 HUDSON BLVD. N SUITE 205
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City | OAKDALE
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State | MN
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Zip | 55128
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Country | US
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Telephone | 651-447-3605
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Fax |
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Provider Business Mailing Address
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Address Line | N7932 US HIGHWAY 63
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City | SPRING VALLEY
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State | WI
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Zip | 54767-7821
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Country | US
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Telephone | 763-242-7041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4173
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License Number State | MN
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