Provider Demographics
NPI:1619412590
Name:KONENKAMP, JO ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JO ANN
Middle Name:
Last Name:KONENKAMP
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 MILE POST DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4756
Mailing Address - Country:US
Mailing Address - Phone:678-662-0922
Mailing Address - Fax:478-287-4804
Practice Address - Street 1:1297 MILE POST DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-4756
Practice Address - Country:US
Practice Address - Phone:678-662-0922
Practice Address - Fax:478-287-4804
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist