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LINDA NANG PHANTHAVONG LICSW
NPI 1508747791
Social Worker - Clinical in New Hope, MN

Active since September 12, 2025PECOS Enrolled
5555 BOONE AVE N, NEW HOPE, MN 55428(651) 774-0011(651) 774-0606 Get Directions Write a Review

NPPES record last updated: October 17, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Linda Nang Phanthavong Licsw NPPES

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

LINDA NANG PHANTHAVONG LICSW (NPI 1508747791) is an individual clinical provider in New Hope, Minnesota, licensed in Minnesota (31962) and active in the NPI registry since September 2025. She is enrolled in Medicare PECOS, maintains a secondary practice location in Brooklyn Park, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1508747791
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameLINDA NANG PHANTHAVONGCredential: LICSW
Location Address5555 BOONE AVE NNew Hope, MN 55428-3636
Mailing Address5555 Boone Ave NNew Hope, MN 55428-3636 · (651) 774-0011 · Fax (651) 774-0606
Phone(651) 774-0011
Fax(651) 774-0606
Sole ProprietorYes
Medical School CMSOtherGraduated 2022
Enumeration DateSeptember 12, 2025
Last NPPES UpdateOctober 17, 2025
NPPES CertifiedOctober 17, 2025
✔ NPI 1508747791 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in MN · 31962
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.
5555 BOONE AVE N, New Hope, MN 55428
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Secondary Practice Location 1

Location 16400 74th Ave NBrooklyn Park, MN 55428-1420 · Phone (612) 816-9369 ext. 69369

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Linda Nang Phanthavong Licsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5294226981
PECOS Enrollment IDI20251111000887
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55428 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.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KRISTIN DIERUF LMFT
Marriage & Family Therapist
5555 BOONE AVE N
NEW HOPE, MN 55428
Hennepin County (651) 774-0011
KATELYN MARIE DONALD
Marriage & Family Therapist
5555 BOONE AVE N
NEW HOPE, MN 55428
Hennepin County (651) 774-0011
SAMANTHA ZILVERBERG LPCC
Counselor (Professional)
5555 BOONE AVE N
NEW HOPE, MN 55428
Hennepin County (651) 774-0011
JALEESA LENOIR MSW, LICSW
Social Worker (Clinical)
5555 BOONE AVE N
NEW HOPE, MN 55428
Hennepin County (651) 774-0011
MARITA K GLASGOW LMFT
Marriage & Family Therapist
5555 BOONE AVE N
NEW HOPE, MN 55428
Hennepin County (651) 774-0011
FARAH AHAMED NOORANI LICSW
Social Worker (Clinical)
5555 BOONE AVE N
NEW HOPE, MN 55428
Hennepin County (651) 774-0011
HANNAH CLAIRE LANGHOLZ LICSW
Social Worker (Clinical)
5555 BOONE AVE N
NEW HOPE, MN 55428
Hennepin County (651) 774-0011
BREE LYNN MEDUNA LICSW
Social Worker (Clinical)
5555 BOONE AVE N
NEW HOPE, MN 55428
Hennepin County (651) 774-0011

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 Linda Phanthavong's NPI number?

The NPI number for Linda Phanthavong is 1508747791. It was assigned to this individual provider in the NPPES registry on September 12, 2025.

Where is Linda Phanthavong located?

Linda Phanthavong practices at 5555 Boone Ave N, New Hope, MN 55428. The listed phone number is (651) 774-0011.

What is Linda Phanthavong's specialty?

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

Is Linda Phanthavong enrolled in Medicare?

Yes. Linda Phanthavong is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Linda Phanthavong was last updated on October 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months 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.