Provider Demographics
NPI:1639308141
Name:KOENIG, EVELINE LOUISE
Entity Type:Individual
Prefix:
First Name:EVELINE
Middle Name:LOUISE
Last Name:KOENIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:LOUISE
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:PO BOX 385586
Mailing Address - Street 2:
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738-0586
Mailing Address - Country:US
Mailing Address - Phone:808-464-0208
Mailing Address - Fax:
Practice Address - Street 1:69-555 WAIKOLOA BEACH DR
Practice Address - Street 2:#301
Practice Address - City:WAIKOLOA
Practice Address - State:HI
Practice Address - Zip Code:96738-5713
Practice Address - Country:US
Practice Address - Phone:808-464-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist