Provider Demographics
NPI:1548797244
Name:KONING, MACENZIE JORDYN (AUD)
Entity Type:Individual
Prefix:MRS
First Name:MACENZIE
Middle Name:JORDYN
Last Name:KONING
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 1:8308 CLARKLAND DR SE
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:MI
Mailing Address - Zip Code:49302-9412
Mailing Address - Country:US
Mailing Address - Phone:616-293-9970
Mailing Address - Fax:
Practice Address - Street 1:751 KENMOOR AVE SE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2391
Practice Address - Country:US
Practice Address - Phone:616-954-1895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist