Provider Demographics
NPI:1336861079
Name:THAO, ZONGLU
Entity Type:Individual
Prefix:
First Name:ZONGLU
Middle Name:
Last Name:THAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 MCKNIGHT RD N
Mailing Address - Street 2:
Mailing Address - City:NORTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2238
Mailing Address - Country:US
Mailing Address - Phone:651-760-3236
Mailing Address - Fax:
Practice Address - Street 1:2365 MCKNIGHT RD N
Practice Address - Street 2:
Practice Address - City:NORTH SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-2238
Practice Address - Country:US
Practice Address - Phone:651-760-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker