Provider Demographics
NPI:1215571153
Name:KOENIG, CHRISTINA ASHLEY (MT-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ASHLEY
Last Name:KOENIG
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 SAUK RD APT 1105
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-8719
Mailing Address - Country:US
Mailing Address - Phone:610-790-7441
Mailing Address - Fax:
Practice Address - Street 1:1610 SAUK RD APT 1105
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-8719
Practice Address - Country:US
Practice Address - Phone:610-790-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist