Provider Demographics
NPI:1336374750
Name:YERKS, SAMANTHA LOUISE (LICSW LGSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LOUISE
Last Name:YERKS
Suffix:
Gender:F
Credentials:LICSW LGSW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LOUISE
Other - Last Name:WIEGAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:22130 TYPO CREEK DR NE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-4602
Mailing Address - Country:US
Mailing Address - Phone:651-271-8970
Mailing Address - Fax:
Practice Address - Street 1:301 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:CIRCLE PINES
Practice Address - State:MN
Practice Address - Zip Code:55014-5008
Practice Address - Country:US
Practice Address - Phone:612-424-1574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302641101Y00000X
MN221171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor