MEDICARE: W KPANGBALA SENGBE SR. EDS, MSW, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	30450	MN

General Provider Information

NPI Number	:	1164017273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	W KPANGBALA SENGBE SR. EDS, MSW, LICSW

Provider Business Mailing Address
First Line	:	2021 E HENNEPIN AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2700
Country	:	US
Telephone Number	:	612-283-6348
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 E HENNEPIN AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2700
Country	:	US
Telephone Number	:	612-283-6348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	12/13/2025

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