Healthcare Provider Details

I. General information

NPI: 1154947216
Provider Name (Legal Business Name): ABBY RUBY SALA MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 SHINGLE CREEK PKWY STE 150
BROOKLYN CENTER MN
55430-2324
US

IV. Provider business mailing address

5910 SHINGLE CREEK PKWY STE 150
BROOKLYN CENTER MN
55430-2324
US

V. Phone/Fax

Practice location:
  • Phone: 763-569-5200
  • Fax: 763-569-5201
Mailing address:
  • Phone: 763-569-5200
  • Fax: 763-569-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24769
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: