Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Samantha Jo Petersen, APSW

Individual provider Social Worker · NPI 1043101991

Samantha Jo Petersen, APSW is a Clinical Social Worker in Menasha, Wisconsin. Qualified in 2025, 1 year ago. Licensed in Wisconsin.

Years since qualifying
1
Licensed in
WI
In the registry since
2025

Practice location Address checks out

1095 Midway Rd
Menasha, WI 54952-1115
Phone: (920) 720-2300
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Social Worker (primary) Taxonomy 104100000X · Licence 135619-121 (WI)

Record details

NPI number1043101991
Entity typeIndividual (Type 1)
GenderFemale
Credentials APSW
Sole proprietorNo
NPI enumeratedJuly 10, 2025
Last updated in NPPESJuly 10, 2025
Certification dateJuly 10, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated

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