Provider Demographics
NPI:1033729785
Name:FLOERSCH, SAMANTHA JO
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JO
Last Name:FLOERSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 192ND ST SE APT Q3
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6896
Mailing Address - Country:US
Mailing Address - Phone:612-388-5553
Mailing Address - Fax:
Practice Address - Street 1:1202 E PINE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3929
Practice Address - Country:US
Practice Address - Phone:206-649-5081
Practice Address - Fax:612-870-6143
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305771101YA0400X
WACP61210985101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)