Individual
KHETLHAMANY ERIKA BANNAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
1253 ELDER RIDGE RD, WEST LIBERTY, IA 52776-9161
(195) 417-7853
Mailing address
1253 ELDER RIDGE RD, WEST LIBERTY, IA 52776-9161
(319) 541-7785
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
114797
IA
235Z00000X
Speech-Language Pathologist
Primary
SL018239
PA
Other
Enumeration date
01/20/2023
Last updated
02/17/2025
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