Provider Demographics
NPI:1124329065
Name:CHANG, ZOUA (PHD)
Entity type:Individual
Prefix:DR
First Name:ZOUA
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 37TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2135
Mailing Address - Country:US
Mailing Address - Phone:612-756-8719
Mailing Address - Fax:651-379-8752
Practice Address - Street 1:393 DUNLAP ST N
Practice Address - Street 2:SUITE 450F
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4200
Practice Address - Country:US
Practice Address - Phone:612-756-8719
Practice Address - Fax:651-379-8752
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5335103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling