Provider Demographics
NPI:1235934704
Name:BORMANN, SAMANTHA MAE (MA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MAE
Last Name:BORMANN
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 8TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1930
Mailing Address - Country:US
Mailing Address - Phone:712-737-9444
Mailing Address - Fax:
Practice Address - Street 1:317 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1930
Practice Address - Country:US
Practice Address - Phone:712-737-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA130431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health