Individual
MR. SAMUEL JOSEPH EGERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5407 EXCELSIOR BLVD STE B, ST LOUIS PARK, MN 55416-2932
(612) 787-2832
Mailing address
1211 JAMES AVE, SAINT PAUL, MN 55105-2920
(314) 753-1627
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
2018038889
MO
106H00000X
Marriage & Family Therapist
Primary
—
MN
Other
Enumeration date
01/15/2019
Last updated
06/15/2021
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