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NPI Code Detail

MEDICARE: SAMANTHA HENRICKSON PLPC

MEDICARE: SAMANTHA HENRICKSON PLPC
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
1101YP2500XProfessional Counselor2026021453MO

General Provider Information

NPI Number : 1790615763
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA HENRICKSON PLPC
Provider Business Mailing Address
First Line : 112 S BROADVIEW ST
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63703-5759
Country : US
Telephone Number : 573-334-3486
Fax Number : 573-334-3524
Provider Business Practice Location Address
First Line : 112 S BROADVIEW ST
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63703-5759
Country : US
Telephone Number : 573-334-3486
Fax Number : 573-334-3524
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 HENRICKSON PLPC” Practice Location

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