Provider Demographics
NPI:1154540946
Name:KONITZER, KRISTINE ANN (MS/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ANN
Last Name:KONITZER
Suffix:
Gender:F
Credentials:MS/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:W2712 STATE ROAD 67
Mailing Address - Street 2:
Mailing Address - City:IRON RIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53035-9658
Mailing Address - Country:US
Mailing Address - Phone:262-305-4659
Mailing Address - Fax:262-673-9727
Practice Address - Street 1:2611 JONES AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2650
Practice Address - Country:US
Practice Address - Phone:719-564-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004293235Z00000X
WI1563-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist