Provider Demographics
NPI:1750026142
Name:PONGKHO, DENIT
Entity Type:Individual
Prefix:
First Name:DENIT
Middle Name:
Last Name:PONGKHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 N CENTRAL EXPY FL 7
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5027
Mailing Address - Country:US
Mailing Address - Phone:972-794-6712
Mailing Address - Fax:
Practice Address - Street 1:9400 N CENTRAL EXPY FL 7
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5027
Practice Address - Country:US
Practice Address - Phone:972-794-6712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-01
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102065235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120085901Medicaid