Provider Demographics
NPI:1669868246
Name:HAGER, SAMANTHA NOEL (LADC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NOEL
Last Name:HAGER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 513
Mailing Address - Street 2:202 BROADWAY AVE.
Mailing Address - City:ORMSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56162
Mailing Address - Country:US
Mailing Address - Phone:507-327-2854
Mailing Address - Fax:
Practice Address - Street 1:305 9TH STREET
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101
Practice Address - Country:US
Practice Address - Phone:507-832-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304136101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)