Provider Demographics
NPI:1427377928
Name:KOENIG, MARCIA LEE (SLP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LEE
Last Name:KOENIG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 W HWY 290
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8400
Mailing Address - Country:US
Mailing Address - Phone:512-744-6025
Mailing Address - Fax:512-334-2325
Practice Address - Street 1:2621 RIDGEPOINT DR
Practice Address - Street 2:SUITE 140
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5232
Practice Address - Country:US
Practice Address - Phone:512-744-6025
Practice Address - Fax:512-334-2325
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10226OtherSPEECH LANGUAGE PATHOLOGIST