Provider Demographics
NPI:1609652502
Name:LANGENBURG, JOY KWAI-LYN
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:KWAI-LYN
Last Name:LANGENBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 ARLINGTON AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-3514
Mailing Address - Country:US
Mailing Address - Phone:612-203-3207
Mailing Address - Fax:
Practice Address - Street 1:8060 HWY 55 STE 100
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MN
Practice Address - Zip Code:55373-9407
Practice Address - Country:US
Practice Address - Phone:612-465-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)