Individual
ANNA PRAVONGVIENGKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8354 E NORTHFIELD BLVD UNIT 3700, DENVER, CO 80238-3135
(480) 757-8090
Mailing address
2266 S DOBSON RD STE 200, MESA, AZ 85202-6412
(480) 757-8090
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
AZ
Other
Enumeration date
06/05/2023
Last updated
10/27/2025
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