Provider Demographics
NPI:1770631954
Name:KOENIG, BONNIE (LAC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:KOENIG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22914 NE 24TH PL
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-6526
Mailing Address - Country:US
Mailing Address - Phone:425-888-1018
Mailing Address - Fax:425-888-0636
Practice Address - Street 1:231 BENDIGO BLVD N
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8259
Practice Address - Country:US
Practice Address - Phone:425-888-1018
Practice Address - Fax:425-888-0636
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000561171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist