Individual
MOLLY SAMUELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5221 VIKING DR STE 300, BLOOMINGTON, MN 55435-5323
(612) 849-4792
Mailing address
5221 VIKING DR STE 300, BLOOMINGTON, MN 55435-5323
(612) 849-4792
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
3243
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260611763
TAX IDENTIFICATION
MN
Enumeration date
03/16/2018
Last updated
10/10/2022
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