Provider Demographics
NPI:1376100966
Name:KONNEKER, MARY (AUD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KONNEKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 HARRISON ST N UNIT 17104
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4295
Mailing Address - Country:US
Mailing Address - Phone:217-899-8163
Mailing Address - Fax:
Practice Address - Street 1:625 POLE LINE RD W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4268
Practice Address - Country:US
Practice Address - Phone:208-814-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist