Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Linda Nang Phanthavong, LICSW

Individual provider Clinical Social Worker · NPI 1508747791

Linda Nang Phanthavong, LICSW is a Clinical Social Worker in New Hope, Minnesota. Qualified in 2022, 4 years ago. Practices as a sole proprietor and works from 2 locations. Licensed in Minnesota.

Years since qualifying
4
Licensed in
MN
In the registry since
2025
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

5555 Boone Ave N
New Hope, MN 55428-3636
Phone: (651) 774-0011
Fax: (651) 774-0606
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 6400 74th Ave N, Brooklyn Park, MN 55428-1420 — (612) 816-9369

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 31962 (MN)

Record details

NPI number1508747791
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorYes
NPI enumeratedSeptember 12, 2025
Last updated in NPPESOctober 17, 2025
Certification dateOctober 17, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Not indicated

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