Provider Demographics
NPI:1386694834
Name:KOONTZ, NATALIE R (MA,CCC-A)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:R
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WELLNESS WAY
Mailing Address - Street 2:CAMERON WELLNESS CENTER
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9697
Mailing Address - Country:US
Mailing Address - Phone:724-228-8212
Mailing Address - Fax:724-228-7767
Practice Address - Street 1:210 WELLNESS WAY
Practice Address - Street 2:CAMERON WELLNESS CENTER
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9697
Practice Address - Country:US
Practice Address - Phone:724-228-8212
Practice Address - Fax:724-228-7767
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005860237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1497874Medicare UPIN
PA069318SKGMedicare ID - Type UnspecifiedAUDIOLOGY