Provider Demographics
NPI:1770372393
Name:THAO, VICKY
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:THAO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 EXCELSIOR BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2932
Mailing Address - Country:US
Mailing Address - Phone:612-283-9221
Mailing Address - Fax:
Practice Address - Street 1:2600 EAGAN WOODS DR STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1152
Practice Address - Country:US
Practice Address - Phone:612-787-2832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist