Amanda Pang Foua Moua, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4152565 Issued in MN

Practice address

1501 Xerxes Ave N
Minneapolis, MN 55411-2851

Phone

(612) 977-3236

Fax

(612) 521-3893

NPI assigned

Jun 27, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• 3C Hansons

  • Mental Health Counselor
  • Richfield, MN
  • NPI 1780221887
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531180800000",
    "number": "1407341837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 XERXES AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554112851",
            "telephone_number": "763-521-3477",
            "fax_number": "763-521-3893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 XERXES AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554112851",
            "telephone_number": "612-977-3236",
            "fax_number": "612-521-3893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUA",
        "first_name": "AMANDA",
        "middle_name": "PANG FOUA",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-27",
        "last_updated": "2018-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "4152565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Walsh Motley, PA-C
• Antoinette Maria Mottl, M.A.
• Ayham Moty, MD
• Greta Motzko
• Maisee Moua-McDaniel, DDS
• Angelina Cha Ia Moua
• Jeanne Moua, MD
• Justin Moua
• Maily Moua
• Mainhia Moua

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.