Samantha Marie Larson, MSW, LCSW
Individual provider Active NPI Clinical Social Worker · Sister Bay, WI
NPI 1740899285 · NPPES record last updated Jan 16, 2026
Key facts
- NPI
- 1740899285
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 11314-123 (WI)
- Practice address
- 2345 Canterbury LN
Sister Bay, WI 54234-5602 - Phone
- (920) 868-3511
- Fax
- (608) 270-0467
- NPI assigned
- Jul 30, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Door County Memorial Hospital
Practice addresses (Care Compare)
2345 Canterbury LN
Sister Bay, WI 54234-5602
Phone (920) 868-3511
323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Phone (920) 743-5566
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230701000436 | WI | Practitioner - Clinical Social Worker | 9032584438 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Door County Memorial Hospital | Current |
Accepting new patients | |
| Door County Memorial Hospital | Current |
Accepting new patients |
Locations
2345 Canterbury Ln
Sister Bay, WI 54234
Phone (920) 380-9890
323 S 18th Ave
Sturgeon Bay, WI 54235
Phone (920) 743-5566
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 131979-121 | WI | |
| Clinical Social Worker | 1041C0700X | 11314-123 | WI | Yes |
Addresses
Primary practice location
2345 Canterbury LN
Sister Bay, WI 54234-5602
Mailing address
323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Other names
- Samantha Prust
Other providers in Sister Bay, WI
- John E Ludwigsen DDS LTD
- Rory Michael Johnson
- Elizabeth Ann Jorgenson
- Krasimira K Kalcheva
- Krista Lee Keck
- Dawn E Lewen
- John Ernest Ludwigsen
- Paige Martin
- Robert Edwin Morley
- Northern Door Chiropractic and Wellness LLC
All providers in Sister Bay, WI · Clinical Social Worker in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.