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General NPI Number Information
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NPI Number | 1174738215
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Entity Type | Organization
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Legal Business Name | SAMPSON PA
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 914 MINNESOTA ST
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City | HIBBING
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State | MN
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Zip | 55746
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Country | US
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Telephone | 218-262-4453
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Fax |
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Provider Business Mailing Address
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Address Line | 225 1ST ST N SUITE 3100
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City | VIRGINIA
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State | MN
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Zip | 55792
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Country | US
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Telephone | 218-741-3740
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Fax |
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Authorized Official
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Title or Position | CEO OWNER
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Name | DR. RAYMOND N SAMPSON
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Credential | PHD LICENSED PSYCHOL
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Telephone | 218-262-4453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP1373
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License Number State | MN
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