Individual
SAMANTHA WIDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1114 GRAND AVE, SAINT PAUL, MN 55105-2628
(630) 803-1954
Mailing address
1114 GRAND AVE, SAINT PAUL, MN 55105-2628
(630) 803-1954
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
03/28/2022
Last updated
03/28/2022
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