Provider Demographics
NPI:1275738650
Name:KOENIG, JENNIFER LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNNE
Last Name:KOENIG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7825 W 115TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2526
Mailing Address - Country:US
Mailing Address - Phone:913-233-8707
Mailing Address - Fax:
Practice Address - Street 1:8207 MELROSE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1625
Practice Address - Country:US
Practice Address - Phone:913-233-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS334106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist