Soukthanome Thammavong, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

4111 Central Ave NE Ste 201
Columbia Heights, MN 55421-2960

Phone

(763) 283-7194

Fax

(612) 437-4535

NPI assigned

Jan 23, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Nome Thammavong Other name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Anoka Health Center LLC

  • Adult Mental Health Clinic/Center
  • Minneapolis, MN
  • NPI 1053816389
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556150400000",
    "number": "1164986246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 BLOOMINGTON AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043074",
            "telephone_number": "612-249-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 CENTRAL AVE NE STE 201",
            "city": "COLUMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554212960",
            "telephone_number": "763-283-7194",
            "fax_number": "612-437-4535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 Bloomington Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554043074",
            "country_code": "US",
            "telephone_number": "612-249-0941",
            "fax_number": "612-301-1040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THAMMAVONG",
        "first_name": "SOUKTHANOME",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-23",
        "last_updated": "2019-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NOME",
            "last_name": "THAMMAVONG",
            "credential": "LICSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mohammad Taha, MD
• Fatuma Abdulrahman Taher
• Taylor Heinlein DDS PA (Ascent Family Dentistry)
• Terrace Haven Care LLC
• Tesfa International School
• Rachael Thompson
• Total Health Clinic Inc.
• Triple S Transportation, Inc.
• Triumph Technology (Handy Tech North America)
• Mary Kay Trueman, CMT

• Clinical Social Worker in Columbia Heights, MN
• Providers in Columbia Heights, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.