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SOUKTHANOME THAMMAVONG LICSW
NPI 1164986246
Social Worker - Clinical in Columbia Heights, MN

Active since January 23, 2019PECOS EnrolledAccepts Medicare Assignment
4111 CENTRAL AVE NE STE 201, COLUMBIA HEIGHTS, MN 55421(763) 283-7194(612) 437-4535 Get Directions Write a Review

NPPES record last updated: April 25, 2019. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Apr 25, 2019, Jan 23, 2019 (2 updates tracked since 2019).

About Soukthanome Thammavong Licsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUKTHANOME THAMMAVONG LICSW (NPI 1164986246) is an individual clinical provider in Columbia Heights, Minnesota and active in the NPI registry since January 2019. She is enrolled in Medicare PECOS, maintains a secondary practice location in Minneapolis, and is a graduate of Other (2008).

NPPES Registry Identity

NPI1164986246
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameSOUKTHANOME THAMMAVONGCredential: LICSW
Location Address4111 CENTRAL AVE NE STE 201Columbia Heights, MN 55421-2960
Mailing Address2001 Bloomington AveMinneapolis, MN 55404-3074 · (612) 249-0941
Phone(763) 283-7194
Fax(612) 437-4535
Sole ProprietorNo
Medical School CMSOtherGraduated 2008
Enumeration DateJanuary 23, 2019
Last NPPES UpdateApril 25, 20192 updates tracked since enumeration
✔ NPI 1164986246 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
4111 CENTRAL AVE NE STE 201, Columbia Heights, MN 55421
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Other Names 1

Other Name (5)Nome Thammavong Licsw

Secondary Practice Location 1

Location 12001 Bloomington AveMinneapolis, MN 55404-3074 · Phone (612) 249-0941 · Fax (612) 301-1040

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Soukthanome Thammavong Licsw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4688914047
PECOS Enrollment IDI20190321000408
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Psychiatric diagnostic evaluation 90791
A psychiatric diagnostic evaluation is a thorough assessment used to identify any mental health conditions you may have. It involves a detailed discussion about your symptoms, thoughts, feelings and behavior patterns. Your medical history and family's mental health history are also considered.
11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55421 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $56.00 – $168.28
Typical copayment $0.00 (range $14.00 – $42.07)
Most-billed visit code NA
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Soukthanome Thammavong's NPI number?

The NPI number for Soukthanome Thammavong is 1164986246. It was assigned to this individual provider in the NPPES registry on January 23, 2019. The provider is also known as Nome Thammavong Licsw.

Where is Soukthanome Thammavong located?

Soukthanome Thammavong practices at 4111 Central Ave NE Ste 201, Columbia Heights, MN 55421. The listed phone number is (763) 283-7194.

What is Soukthanome Thammavong's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Soukthanome Thammavong enrolled in Medicare?

Yes. Soukthanome Thammavong is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Soukthanome Thammavong accept?

Health plans from HealthPartners list Soukthanome Thammavong as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Soukthanome Thammavong was last updated on April 25, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.