1184076473 NPI number — SAMANTHA PLUMSKI LICSW

Table of content: SAMANTHA PLUMSKI LICSW (NPI 1184076473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184076473 NPI number — SAMANTHA PLUMSKI LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLUMSKI
Provider First Name:
SAMANTHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184076473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 25TH ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58103-2311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-451-4900
Provider Business Mailing Address Fax Number:
651-925-0057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 37TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORHEAD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56560-5524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-451-4811
Provider Business Practice Location Address Fax Number:
651-925-0057
Provider Enumeration Date:
07/11/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  18629 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)