Provider Demographics
NPI:1154947216
Name:SALA, ABBY RUBY (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:RUBY
Last Name:SALA
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 SHINGLE CREEK PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2324
Mailing Address - Country:US
Mailing Address - Phone:763-569-5200
Mailing Address - Fax:763-569-5201
Practice Address - Street 1:5910 SHINGLE CREEK PKWY STE 150
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2324
Practice Address - Country:US
Practice Address - Phone:763-569-5200
Practice Address - Fax:763-569-5201
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN247691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical