| NPI | 1750929063 |
|---|---|
| Former Name | SAMANTHA ROSE DERDOWSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801122723) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2026-08-05 |