Provider Demographics
NPI:1366008336
Name:SOUNG, ELIZABETH K (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:SOUNG
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 DALE ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1917
Mailing Address - Country:US
Mailing Address - Phone:651-329-5454
Mailing Address - Fax:651-487-7637
Practice Address - Street 1:569 DALE ST N STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1917
Practice Address - Country:US
Practice Address - Phone:651-329-5454
Practice Address - Fax:651-487-7637
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24724104100000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No104100000XBehavioral Health & Social Service ProvidersSocial Worker