Provider Demographics
NPI:1497703631
Name:KOENIG, MARIA (4183)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:KOENIG
Suffix:
Gender:F
Credentials:4183
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 CRAVEN BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:RAMSEUR
Mailing Address - State:NC
Mailing Address - Zip Code:27316-8490
Mailing Address - Country:US
Mailing Address - Phone:336-879-6495
Mailing Address - Fax:336-879-6495
Practice Address - Street 1:3208 CRAVEN BRANCH RD
Practice Address - Street 2:
Practice Address - City:RAMSEUR
Practice Address - State:NC
Practice Address - Zip Code:27316-8490
Practice Address - Country:US
Practice Address - Phone:336-879-6495
Practice Address - Fax:336-879-6495
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4183235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411128Medicaid