Samantha Jo Luedtke, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC3202 Issued in MN

Practice address

2400 W 64TH St
Richfield, MN 55423-1001

Phone

(612) 767-7222

NPI assigned

Feb 23, 2022

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

Other names 1

• Samantha Jo Bahr 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

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 and National Provider Directory roles.

• Fraser Child and Family Center

  • Adolescent and Children Mental Health Clinic/Center
  • Minneapolis, MN
  • NPI 1609922194
  Medicare reassignment NPD
• Lee Carlson Center for Mental Health and Well-Being

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fridley, MN
  • NPI 1457455057
  NPD (past)

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

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680220800000",
    "number": "1831845346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 W 64TH ST",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554231001",
            "telephone_number": "612-767-7222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 W 64TH ST",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554231001",
            "telephone_number": "612-767-7222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUEDTKE",
        "first_name": "SAMANTHA",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-23",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC3202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "BAHR",
            "middle_name": "JO",
            "credential": "LPCC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Linda Jean Logan, MASTER OF ARTS
• Andrew Thomas Lokers, MA, LPC, LADC
• Anthony Peter Lombardo, M.S.
• Ariana Diane Lopez, PT, DPT
• Aubree Lotko
• Lynette Lund, LICSW
• Wallace Earl Lunden III, DDS
• Luxottica of America Inc (Target Optical #2194)
• Madelyn Steen, LLC (v)
• Maggie Johnson LPCC LLC

• Professional Counselor in Richfield, MN
• Providers in Richfield, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.

Verify at the official NPI Registry.