Healthcare Provider Details

I. General information

NPI: 1881945699
Provider Name (Legal Business Name): PAO K YANG APSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 TECHNOLOGY DR E
MENOMONIE WI
54751-2370
US

IV. Provider business mailing address

203 UNITED WAY
FREDERIC WI
54837-8938
US

V. Phone/Fax

Practice location:
  • Phone: 715-235-4245
  • Fax: 715-235-4421
Mailing address:
  • Phone: 715-327-4322
  • Fax: 715-327-8509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127657-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: