Active NPI
Andrea Phouthavong
- Social Worker
- Circleville, OH
National Provider Identifier
1104526409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.2308869
- Practice address
- 319 Logan St
Circleville, OH 43113-2213 - Phone
- (740) 474-8874
- NPI assigned
- Mar 6, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.2308869 | OH | Primary |
Addresses
Primary practice location
319 Logan St
Circleville, OH 43113-2213
Mailing address
4449 State Route 159
Chillicothe, OH 45601-8620
Phone (740) 775-1260
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.2308869 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678060800000",
"number": "1104526409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4449 STATE ROUTE 159",
"city": "CHILLICOTHE",
"state": "OH",
"postal_code": "456018620",
"telephone_number": "740-775-1260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "319 LOGAN ST",
"city": "CIRCLEVILLE",
"state": "OH",
"postal_code": "431132213",
"telephone_number": "740-474-8874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHOUTHAVONG",
"first_name": "ANDREA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-06",
"last_updated": "2023-03-06",
"certification_date": "2023-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.2308869",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Circleville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.