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General NPI Number Information
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NPI Number | 1992516025
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Entity Type | Individual
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Provider Name | MAI-LINH PHAM LGSW
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Gender | Female
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 7300 147TH ST W STE 600
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City | APPLE VALLEY
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State | MN
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Zip | 55124-7850
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Country | US
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Telephone | 952-997-3020
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Fax |
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Provider Business Mailing Address
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Address Line | 6605 JEFFERY BAY S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4178
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Country | US
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Telephone | 651-347-2101
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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 | 32813
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License Number State | MN
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