Active NPI
Kathleen Ann Samilo, MA, LP
- Psychologist
- Saint Paul, MN
National Provider Identifier
1376655761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP 0249
- Practice address
- 1867 Saint Clair Ave
Saint Paul, MN 55105-1642 - Phone
- (651) 402-3458
- Fax
- (763) 780-0784
- NPI assigned
- Aug 31, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP 0249 | MN | Primary |
Addresses
Primary practice location
1867 Saint Clair Ave
Saint Paul, MN 55105-1642
Mailing address
1485 81St Ave NE
Spring Lake Park, MN 55432-2111
Phone (763) 780-3036
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP 0249 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376655761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1485 81ST AVE NE",
"city": "SPRING LAKE PARK",
"state": "MN",
"postal_code": "554322111",
"telephone_number": "763-780-3036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1867 SAINT CLAIR AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551051642",
"telephone_number": "651-402-3458",
"fax_number": "763-780-0784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMILO",
"first_name": "KATHLEEN",
"middle_name": "ANN",
"credential": "MA, LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP 0249",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.