Provider Demographics
NPI:1366518029
Name:KOONS, WILLIAM R (BC HIS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:KOONS
Suffix:
Gender:M
Credentials:BC HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15218 E BB HWY
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772
Mailing Address - Country:US
Mailing Address - Phone:417-321-5480
Mailing Address - Fax:417-667-5566
Practice Address - Street 1:1506 W. AUSTIN
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772
Practice Address - Country:US
Practice Address - Phone:417-321-5480
Practice Address - Fax:417-667-5566
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001012844237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist