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1962982017
SAMOUT KETTAVONG
DALLAS, TX
NPI
1962982017
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
235Z00000X Speech-Language Pathologist,
(Licence: TX 114529)
Enumeration Date
2018-08-17
Last Update Date
2022-05-24
Business Address
SAMOUT KETTAVONG CCC-SLP
1881 SYLVAN AVE # 150
DALLAS, TX 75208-2083
Phone number: 214-333-7041
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Mailing Address
SAMOUT KETTAVONG CCC-SLP
1881 SYLVAN AVE # 150
DALLAS, TX 75208-2083
Phone number:
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