Provider Demographics
NPI:1528736576
Name:KOENIGSKNECHT, JOCELYN RAE ESSLER (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:RAE ESSLER
Last Name:KOENIGSKNECHT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-8746
Mailing Address - Country:US
Mailing Address - Phone:701-212-5316
Mailing Address - Fax:
Practice Address - Street 1:402 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-8746
Practice Address - Country:US
Practice Address - Phone:701-212-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001585235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003265166OtherORGANIZATION NPI