Soukthanome Thammavong, LICSW

NPI #1164986246 in Columbia Heights, Minnesota

Provider Information

NPI Number: 1164986246
Entity Type: Individual
Name: Soukthanome Thammavong, LICSW
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker - Clinical
Credential: LICSW
Enumeration Date: Jan 23, 2019
Last Updated: Apr 25, 2019

Practice Location

Address: 4111 CENTRAL AVE NE STE 201
City: Columbia Heights
State: Minnesota
ZIP Code: 55421-2960
Phone: (763) 283-7194

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary

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