Provider Demographics
NPI:1497839948
Name:KONING, AUDRA K (SLP)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:K
Last Name:KONING
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:K
Other - Last Name:LOVELACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1105 N VIKING CT
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64056-3238
Mailing Address - Country:US
Mailing Address - Phone:816-808-5089
Mailing Address - Fax:
Practice Address - Street 1:FORT OSAGE R-I
Practice Address - Street 2:2101 N TWYMAN ROAD
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64058-3200
Practice Address - Country:US
Practice Address - Phone:816-796-8762
Practice Address - Fax:816-796-3657
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117369235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist