Individual
KATHY M KHOMMANYVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
720 KENYON RD, NORTH CENTRAL IOWA MHC DBA BERRYHILL CENTER FOR MENTAL, FORT DODGE, IA 50501-0000
(515) 955-7171
(515) 573-7898
Mailing address
720 KENYON RD, NORTH CENTRAL IOWA MHC DBA BERRYHILL CENTER FOR MENTAL, FORT DODGE, IA 50501-0000
(515) 955-7171
(515) 573-7898
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
03941
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0159608
—
IA
01
—
07466
WELLMARK BC/BS
IA
Enumeration date
02/09/2007
Last updated
02/09/2009
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