Samantha Louise Yerks, LICSW LGSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

22117 Issued in MN

Practice address

4801 Highway 61 N Ste 204
White Bear LK, MN 55110-2752

Phone

(763) 465-6700

Fax

(833) 590-9800

NPI assigned

May 29, 2009

Last updated

May 23, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Samantha Louise Wiegand Former name

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 Social Worker

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Introspect Mental Health LLCGroup PAC ID 9931502796, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Introspect Mental Health LLC

  • Mental Health Counselor
  • White Bear LK, MN
  • NPI 1184273666
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1243555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1336374750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22130 TYPO CREEK DR NE",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550924602",
            "telephone_number": "651-271-8970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 HIGHWAY 61 N STE 204",
            "city": "WHITE BEAR LK",
            "state": "MN",
            "postal_code": "551102752",
            "telephone_number": "763-465-6700",
            "fax_number": "833-590-9800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "144 2nd Ave SE",
            "address_purpose": "LOCATION",
            "city": "Cambridge",
            "state": "MN",
            "postal_code": "550081601",
            "country_code": "US",
            "telephone_number": "763-465-6700",
            "fax_number": "833-590-9800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YERKS",
        "first_name": "SAMANTHA",
        "middle_name": "LOUISE",
        "credential": "LICSW LGSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-29",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MN",
            "license": "302641",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "22117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "WIEGAND",
            "middle_name": "LOUISE",
            "credential": "LADC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Montanna Ruth Remick
• William Snowball
• Madison Taylor Stackhouse
• Lee Thao
• Venture Therapy, LLC

• Clinical Social Worker in White Bear LK, MN
• Providers in White Bear LK, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; 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.