Provider Demographics
NPI:1497346803
Name:ROOTS MUSIC THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:ROOTS MUSIC THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:HALLGREN
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC
Authorized Official - Phone:651-500-5422
Mailing Address - Street 1:3748 MCCRACKEN LN # A
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3229
Mailing Address - Country:US
Mailing Address - Phone:651-500-5422
Mailing Address - Fax:
Practice Address - Street 1:3748 MCCRACKEN LN
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-3229
Practice Address - Country:US
Practice Address - Phone:651-500-5422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty