Provider Demographics
NPI:1447357314
Name:YANG, PHUA (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:PHUA
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 EMPIRE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1856
Mailing Address - Country:US
Mailing Address - Phone:651-344-4931
Mailing Address - Fax:651-472-5087
Practice Address - Street 1:23 EMPIRE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1856
Practice Address - Country:US
Practice Address - Phone:651-344-4931
Practice Address - Fax:651-472-5087
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN155891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical