Healthcare Provider Details

I. General information

NPI: 1710892377
Provider Name (Legal Business Name): MARY YER VANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 MCELWAIN BLVD
DENVER CO
80229-5144
US

IV. Provider business mailing address

3490 E 102ND AVE
THORNTON CO
80229-2894
US

V. Phone/Fax

Practice location:
  • Phone: 303-853-1360
  • Fax:
Mailing address:
  • Phone: 918-315-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number24523056
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: