Provider Demographics
NPI:1699713248
Name:INTHAVONG, HEIDI P
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:P
Last Name:INTHAVONG
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 1:6362 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1506
Mailing Address - Country:US
Mailing Address - Phone:913-663-2555
Mailing Address - Fax:913-663-3766
Practice Address - Street 1:6362 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1506
Practice Address - Country:US
Practice Address - Phone:913-663-2555
Practice Address - Fax:913-663-3766
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist