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1245945567
KHETLHAMANY ERIKA BANNAVONG
CORALVILLE, IA
NPI
1245945567
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
235Z00000X Speech-Language Pathologist
(Licence: IA 114797)
Enumeration Date
2023-01-20
Last Update Date
2023-01-20
Business Address
KHETLHAMANY ERIKA BANNAVONG M.A., CF-SLP
2332 LIBERTY DR
CORALVILLE, IA 52241-2771
Phone number: 319-545-7390
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Mailing Address
KHETLHAMANY ERIKA BANNAVONG M.A., CF-SLP
4560 SE INTERNATIONAL WAY STE 100
MILWAUKIE, OR 97222-4628
Phone number:
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