Provider Demographics
NPI:1811541717
Name:YANG, XAY (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:XAY
Middle Name:
Last Name:YANG
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 1:1121 JACKSON ST NE STE 500
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1672
Mailing Address - Country:US
Mailing Address - Phone:612-874-7063
Mailing Address - Fax:
Practice Address - Street 1:1121 JACKSON ST NE STE 500
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1672
Practice Address - Country:US
Practice Address - Phone:612-874-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23750104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty