Viengkeo Chanthaloth- Phasouk, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.022418 Issued in IL

Practice address

2704 N Main St
Rockford, IL 61103-3112

Phone

(815) 391-1000

Fax

(815) 815-7204

NPI assigned

Aug 6, 2018

Last updated

Aug 13, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Viengkeo Phasouk Professional name

Medicare fee-for-service enrollment

Enrolled in IL

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Aspen Counseling and Consulting LLCGroup PAC ID 9335376805, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aspen Counseling & Consulting LLC

  • Community/Behavioral Health Agency
  • Rockford, IL
  • NPI 1326288994
  Medicare reassignment Care Compare group NPD
• Rosecrance Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rockford, IL
  • NPI 1013289446
  Medicare reassignment NPD
• Rosecrance Inc

  dba Rosecrance Ware Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rockford, IL
  • NPI 1346656923
  NPD
• Rosecrance Inc

  dba Rosecrance

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Moline, IL
  • NPI 1639892698
  NPD
• Aspen Counseling and Consulting LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Madison, WI
  • NPI 1407287394
  NPD

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

{
    "created_epoch": "1533513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597276800000",
    "number": "1366920811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 N MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611073877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2704 N MAIN ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033112",
            "telephone_number": "815-391-1000",
            "fax_number": "815-815-7204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANTHALOTH- PHASOUK",
        "first_name": "VIENGKEO",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-06",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.022418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VIENGKEO",
            "last_name": "PHASOUK",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Daniel F Chamberlain, MD
• Meredith Chance, LCSW
• Nisha Chandran, MD
• Changes Place
• Judy Chanthalangsy, O.D.
• Logan John Chapman-Neal
• Heather Chapman
• Charles R. Welford MD SC
• James Chatham Jr., M.D.
• Arshan Z Chaudhri, MD

• Clinical Social Worker in Rockford, IL
• Providers in Rockford, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; 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.