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

Soukthanome Thammavong, LICSW

Individual provider Clinical Social Worker · NPI 1164986246

Soukthanome Thammavong, LICSW is a Clinical Social Worker in Columbia Heights, Minnesota. Qualified in 2008, 18 years ago. Works from 2 locations and accepts Medicare assignment.

Years since qualifying
18
In the registry since
2019
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

See every abbreviation used in this directory →

Practice location Address checks out

4111 Central Ave NE Ste 201
Columbia Heights, MN 55421-2960
Phone: (763) 283-7194
Fax: (612) 437-4535
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2001 Bloomington Ave, Minneapolis, MN 55404-3074 — (612) 249-0941

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X

Record details

NPI number1164986246
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorNo
NPI enumeratedJanuary 23, 2019
Last updated in NPPESApril 25, 2019

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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