MEDICARE: SAMANTHA QUIRK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	136056-121	WI

General Provider Information

NPI Number	:	1518897438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA QUIRK

Provider Business Mailing Address
First Line	:	5872 22ND ST
Second Line	:
City	:	ELK MOUND
State	:	WI
Zip	:	54739-5032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2722 EDDY LN
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703-1204
Country	:	US
Telephone Number	:	715-770-9180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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Directions to “ SAMANTHA QUIRK ” Practice Location

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