Provider Demographics
NPI:1003233354
Name:BIRRENKOTT, SAMANTHA JANE (LSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:BIRRENKOTT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:ND
Mailing Address - Zip Code:58561-7010
Mailing Address - Country:US
Mailing Address - Phone:701-754-2283
Mailing Address - Fax:701-754-2282
Practice Address - Street 1:301 BROADWAY
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:ND
Practice Address - Zip Code:58561-7010
Practice Address - Country:US
Practice Address - Phone:701-754-2283
Practice Address - Fax:701-754-2282
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4790171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator