Provider Demographics
NPI:1033721618
Name:PHONGXAYSANITH, KARA NOELLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:NOELLE
Last Name:PHONGXAYSANITH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WILLOW VALLEY LAKES DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9051
Mailing Address - Country:US
Mailing Address - Phone:177-464-6861
Mailing Address - Fax:717-464-8444
Practice Address - Street 1:900 WILLOW VALLEY LAKES DR
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9051
Practice Address - Country:US
Practice Address - Phone:717-464-6861
Practice Address - Fax:717-464-8444
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007028235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist