Samout Kettavong, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

114529 Issued in TX

Practice address

3230 Remond Dr
Dallas, TX 75211-1619

Phone

(214) 743-1200

NPI assigned

Aug 17, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Dallas County Mental Health & Mental Retardation Center

  • Psychiatry Physician
  • Dallas, TX
  • NPI 1023239886
  NPD

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

{
    "created_epoch": "1534464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778457600000",
    "number": "1962982017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1881 SYLVAN AVE STE 150",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752082002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3230 REMOND DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752111619",
            "telephone_number": "214-743-1200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1881 Sylvan Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752082030",
            "country_code": "US",
            "telephone_number": "214-333-7041",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1881 Sylvan Ave Ste 150",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752082002",
            "country_code": "US",
            "telephone_number": "214-743-1200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KETTAVONG",
        "first_name": "SAMOUT",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-17",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "114529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Howard Kessner, D.M.D
• Adele Kestner, D.C.
• Kirsten Micaela Ketchersid
• Linda Sherilyn (Sheri) Ketchum, MSN RN
• Karena Kett
• Anton Sebastian Ketterer, MD
• Michele A Kettles, MD
• Arunima Jayaram Ketu
• Heejo Keum
• Kevin B. Waldrep, M.D.,PLLC

• Speech-Language Pathologist in Dallas, TX
• Providers in Dallas, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; 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.