Active NPI
Samantha Lee Woller, LMFT
- Marriage & Family Therapist
- Saint Cloud, MN
National Provider Identifier
1104601335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 4387
- Practice address
- 110 6TH Ave S # 100
Saint Cloud, MN 56301-5209 - Phone
- (320) 253-5930
- NPI assigned
- Aug 28, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 4387 | MN | Primary |
Addresses
Primary practice location
110 6TH Ave S # 100
Saint Cloud, MN 56301-5209
Mailing address
116 Cole CT
Mankato, MN 56001-6426
Phone (507) 779-9001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4387 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693180800000",
"number": "1104601335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 COLE CT",
"city": "MANKATO",
"state": "MN",
"postal_code": "560016426",
"telephone_number": "507-779-9001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 6TH AVE S # 100",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563015209",
"telephone_number": "320-253-5930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLLER",
"first_name": "SAMANTHA",
"middle_name": "LEE",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-28",
"last_updated": "2023-08-28",
"certification_date": "2023-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "4387",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.