MEDICARE: ROYCE KELLY VANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	4282	MN

General Provider Information

NPI Number	:	1730941550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROYCE KELLY VANG

Provider Business Mailing Address
First Line	:	17377 91ST AVE N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-5403
Country	:	US
Telephone Number	:	651-260-3298
Fax Number	:

Provider Business Practice Location Address
First Line	:	731 7TH ST E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-5048
Country	:	US
Telephone Number	:	651-967-2506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2024
Last Update Date	:	01/26/2024

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Directions to “ ROYCE KELLY VANG ” Practice Location

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