| Doctor Name: | KATHY M KHOMMANYVONG |
| NPI Number: | 1033250402 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | 03941 |
| Business Practice Address: | 720 Kenyon Rd North Central Iowa Mhc Dba Berryhill Center For Mental Fort Dodge, IA - 505010000 |
| Business Phone Number: | 5159557171 |
| Business Fax Number: | 5155737898 |
| Mailing Address: | 720 Kenyon Rd, North Central Iowa Mhc Dba Berryhill Center For Mental FORT DODGE |
| State: | IA |
| Postal Code: | 505010000 |
| Phone Number: | 5159557171 |
| Fax Number: | 5155737898 |
| NPI Enumeration Date: | 02/09/2007 |
| NPI Last Update Date: | 02/09/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 03941 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |