=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942147640
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | XIANWEN CAO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2026
-----------------------------------------------------
Last Update Date | 04/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1250 MOORE LAKE DR E STE 152
-----------------------------------------------------
City | FRIDLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55432-5135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-389-2332
-----------------------------------------------------
Fax | 612-389-2338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1250 MOORE LAKE DR E STE 152
-----------------------------------------------------
City | FRIDLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55432-5135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-389-2332
-----------------------------------------------------
Fax | 612-389-2338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------