Healthcare Provider Details

I. General information

NPI: 1003512542
Provider Name (Legal Business Name): ELIZABETH KANGAS MSW, LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 TOWN CENTRE DR
EAGAN MN
55123-1199
US

IV. Provider business mailing address

19 OVERLOOK RD
DELLWOOD MN
55110-1426
US

V. Phone/Fax

Practice location:
  • Phone: 952-295-8831
  • Fax:
Mailing address:
  • Phone: 651-252-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number36440
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: