Provider Demographics
NPI:1629709407
Name:VANG, HOUA (LICSW)
Entity Type:Individual
Prefix:
First Name:HOUA
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 WOODLANE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3055
Mailing Address - Country:US
Mailing Address - Phone:651-283-3794
Mailing Address - Fax:651-738-1881
Practice Address - Street 1:2165 WOODLANE DR STE 100
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3055
Practice Address - Country:US
Practice Address - Phone:651-283-3794
Practice Address - Fax:651-738-1881
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN272941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical