Provider Demographics
NPI:1093433856
Name:DEGAND, SAMANTHA JOANN
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOANN
Last Name:DEGAND
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 1:2304 SKYVUE LN
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-3178
Mailing Address - Country:US
Mailing Address - Phone:785-320-5505
Mailing Address - Fax:785-320-5517
Practice Address - Street 1:2304 SKYVUE LN
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3178
Practice Address - Country:US
Practice Address - Phone:785-320-5505
Practice Address - Fax:785-320-5517
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01130101YA0400X
KS0108-T101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)