Provider Demographics
NPI:1689085946
Name:VANG, MENG (LICSW)
Entity Type:Individual
Prefix:
First Name:MENG
Middle Name:
Last Name:VANG
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:110
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-379-1718
Mailing Address - Fax:651-379-1738
Practice Address - Street 1:11010 PRAIRIE LAKES DR
Practice Address - Street 2:350
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3884
Practice Address - Country:US
Practice Address - Phone:952-746-2522
Practice Address - Fax:952-746-0887
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN182561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical