Healthcare Provider Details

I. General information

NPI: 1306419007
Provider Name (Legal Business Name): SENGSAVANG INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 NORMANDALE LAKE BLVD STE 350
BLOOMINGTON MN
55437-3805
US

IV. Provider business mailing address

8500 NORMANDALE LAKE BLVD STE 350
BLOOMINGTON MN
55437-3805
US

V. Phone/Fax

Practice location:
  • Phone: 612-234-1823
  • Fax:
Mailing address:
  • Phone: 612-234-1823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KEO SENGSAVANG
Title or Position: OWNER
Credential: LPCC
Phone: 612-234-2397