Provider Demographics
NPI:1457536278
Name:THAO, TRUE JACOB (MSW)
Entity Type:Individual
Prefix:MR
First Name:TRUE
Middle Name:JACOB
Last Name:THAO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6940 KEATS AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-1311
Mailing Address - Country:US
Mailing Address - Phone:651-247-3276
Mailing Address - Fax:651-769-0321
Practice Address - Street 1:6940 KEATS AVE S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-1311
Practice Address - Country:US
Practice Address - Phone:651-247-3276
Practice Address - Fax:651-769-0321
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1117691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical