Healthcare Provider Details

I. General information

NPI: 1114864824
Provider Name (Legal Business Name): SUSAN KASHIA VANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 FINN ST S
SAINT PAUL MN
55105-1012
US

IV. Provider business mailing address

1570 EUSTIS ST APT 230
LAUDERDALE MN
55108-1279
US

V. Phone/Fax

Practice location:
  • Phone: 612-962-6750
  • Fax:
Mailing address:
  • Phone: 920-450-8297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: