MEDICARE: SAMANTHA PONGRACZ

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	101Y00000X	Counselor	2024044870	MO

General Provider Information

NPI Number	:	1740130194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA PONGRACZ

Provider Business Mailing Address
First Line	:	9632 HUBER RD
Second Line	:
City	:	HILLSBORO
State	:	MO
Zip	:	63050-3708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 CLIFF CAVE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-3650
Country	:	US
Telephone Number	:	314-635-7018
Fax Number	:

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “ SAMANTHA PONGRACZ ” Practice Location

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