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General NPI Number Information
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NPI Number | 1518728245
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Entity Type | Individual
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Provider Name | KINGSLEY CHIGBU PH.D. L.I.C.S.W
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Gender | Male
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 2115 SUMMIT AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-1048
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Country | US
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Telephone | 612-940-9363
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Fax |
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Provider Business Mailing Address
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Address Line | 12423 66TH PL N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-6060
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Country | US
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Telephone | 612-940-9363
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19712
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License Number State | MN
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