Provider Demographics
NPI:1740023225
Name:NGO, MINH NGOC (MSE)
Entity type:Individual
Prefix:
First Name:MINH NGOC
Middle Name:
Last Name:NGO
Suffix:
Gender:
Credentials:MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E MANKATO ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-1844
Mailing Address - Country:US
Mailing Address - Phone:218-940-2657
Mailing Address - Fax:
Practice Address - Street 1:15300 WATERTOWN PLANK RD STE 106
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2348
Practice Address - Country:US
Practice Address - Phone:414-807-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty