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NPI Code Detail

MEDICARE: LEONA L VANN LICSW

MEDICARE: LEONA L VANN LICSW
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
11041C0700XClinical Social Worker30264MN

General Provider Information

NPI Number : 1063375905
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEONA L VANN LICSW
Provider Business Mailing Address
First Line : 1600 UNIVERSITY AVE W STE 12
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-3952
Country : US
Telephone Number : 651-379-5157
Fax Number :
Provider Business Practice Location Address
First Line : 1600 UNIVERSITY AVE W STE 12
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-3952
Country : US
Telephone Number : 651-379-5157
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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Directions to “ LEONA L VANN LICSW” Practice Location

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