Provider Demographics
NPI:1821611146
Name:CHUNG, SHARON KEUN HAE (LICSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KEUN HAE
Last Name:CHUNG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 RANDOLPH ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2621
Mailing Address - Country:US
Mailing Address - Phone:347-406-3782
Mailing Address - Fax:
Practice Address - Street 1:5700 BOTTINEAU BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-3184
Practice Address - Country:US
Practice Address - Phone:763-504-6590
Practice Address - Fax:763-531-2105
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN257651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical