Provider Demographics
NPI:1588327498
Name:FITZGERALD, SAMANTHA M
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:M
Other - Last Name:ROUMPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFFS
Mailing Address - State:NE
Mailing Address - Zip Code:68015-0066
Mailing Address - Country:US
Mailing Address - Phone:402-628-2080
Mailing Address - Fax:402-628-2108
Practice Address - Street 1:110 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFFS
Practice Address - State:NE
Practice Address - Zip Code:68015-3128
Practice Address - Country:US
Practice Address - Phone:402-628-2080
Practice Address - Fax:402-628-2108
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health