Samantha Colombo, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP7289 Issued in MN

Practice address

5218 Matterhorn Dr NE
Fridley, MN 55421-1334

Phone

(218) 830-1166

NPI assigned

Nov 24, 2025

Last updated

Nov 24, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Life Development Resources PAGroup PAC ID 5890779847, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Life Development Resources, PA

  • Community/Behavioral Health Agency
  • Lakeville, MN
  • NPI 1902953169

  Clinical

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1763942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763942400000",
    "number": "1205797701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5218 MATTERHORN DR NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554211334",
            "telephone_number": "218-830-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5218 MATTERHORN DR NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554211334",
            "telephone_number": "218-830-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLOMBO",
        "first_name": "SAMANTHA",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-11-24",
        "last_updated": "2025-11-24",
        "certification_date": "2025-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP7289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clear Passage Counseling
• Keith Clepper, LICSW, LADC
• Brian Paul Cloutier
• Mekena Coakley, MS, LADC, LPCC
• Dale Lee Cody, M.D.
• Columbia Park Medical Group, PA
• Columbia Park Medical Group, PA
• Columbia Park Medical Group, PA
• Columbia Park Medical Group, PA
• Community Options Fridley Inc.

• Clinical Psychologist in Fridley, MN
• Providers in Fridley, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.