Provider Demographics
NPI:1518022797
Name:CHANG, LEE (LICSW)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 1ST AVE NE STE 111BB
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-4489
Mailing Address - Country:US
Mailing Address - Phone:507-990-3225
Mailing Address - Fax:507-288-3222
Practice Address - Street 1:1500 1ST AVE NE STE 111BB
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4489
Practice Address - Country:US
Practice Address - Phone:507-990-3225
Practice Address - Fax:507-288-3222
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN155201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical