Khetlhamany Erika Bannavong, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SL018239 Issued in PA

Practice address

1253 Elder Ridge Rd
West Liberty, IA 52776-9161

Phone

(195) 417-7853

NPI assigned

Jan 20, 2023

Last updated

Feb 17, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Empowerme Asl, LLC

  • Multi-Specialty Clinic/Center
  • Fort Madison, IA
  • NPI 1376138305

  Speech-Language Pathologist

  NPD
• Empowerme Asl, LLC

  • Rehabilitation Clinic/Center
  • Grand Island, NE
  • NPI 1447944657
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1245945567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1253 ELDER RIDGE RD",
            "city": "WEST LIBERTY",
            "state": "IA",
            "postal_code": "527769161",
            "telephone_number": "319-541-7785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1253 ELDER RIDGE RD",
            "city": "WEST LIBERTY",
            "state": "IA",
            "postal_code": "527769161",
            "telephone_number": "195-417-7853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANNAVONG",
        "first_name": "KHETLHAMANY",
        "middle_name": "ERIKA",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-20",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IA",
            "license": "114797",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL018239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Active Health Chiropractic Clinic, P.C.
• Christine Blake, APRN
• City of West Liberty
• City of West Liberty (West Liberty Volunteer Fire Department)
• Carolyn Ann Duong, DDS
• Gentle Family Dentists

• Speech-Language Pathologist in West Liberty, IA
• Providers in West Liberty, IA by specialty
• Speech-Language Pathologist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.