Linda Nang Phanthavong, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

31962 Issued in MN

Practice address

5555 Boone Ave N
New Hope, MN 55428-3636

Phone

(651) 774-0011

Fax

(651) 774-0606

NPI assigned

Sep 12, 2025

Last updated

Oct 17, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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, 2022

Medicare assignment

May accept Medicare assignment

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

• People Incorporated

  • Community/Behavioral Health Agency
  • Minneapolis, MN
  • NPI 1215104831

  Multi-Specialty

  Medicare reassignment NPD
• People Incorporated

  • Community/Behavioral Health Agency
  • New Hope, MN
  • NPI 1720356900

  Multi-Specialty

  NPD

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

{
    "created_epoch": "1757635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760659200000",
    "number": "1508747791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 BOONE AVE N",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554283636",
            "telephone_number": "651-774-0011",
            "fax_number": "651-774-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 BOONE AVE N",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554283636",
            "telephone_number": "651-774-0011",
            "fax_number": "651-774-0606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6400 74th Ave N",
            "address_purpose": "LOCATION",
            "city": "Brooklyn Park",
            "state": "MN",
            "postal_code": "554281420",
            "country_code": "US",
            "telephone_number": "612-816-9369 x69369",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHANTHAVONG",
        "first_name": "LINDA",
        "middle_name": "NANG",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-09-12",
        "last_updated": "2025-10-17",
        "certification_date": "2025-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "31962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Peterson, DDS
• Grant Peterson
• Michelle Peterson, OTR/L
• Paul S. Peterson
• Treya Pettit
• Jason Wendell Phillips, D.C.
• Pioneer Dental, P.a.
• Post-Acute Physicians of Minnesota
• Laura M Pothast, PA
• Joshua Norris Powell, LICSW

• Clinical Social Worker in New Hope, MN
• Providers in New Hope, 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 Oct 17, 2025; 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.