Provider Demographics
NPI:1861664096
Name:MAIONCHI, KERYN ELISABETH (AUD)
Entity Type:Individual
Prefix:
First Name:KERYN
Middle Name:ELISABETH
Last Name:MAIONCHI
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:PO BOX 9190
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80932-0190
Mailing Address - Country:US
Mailing Address - Phone:719-867-7800
Mailing Address - Fax:719-867-7899
Practice Address - Street 1:3030 N CIRCLE DR
Practice Address - Street 2:STE 300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1177
Practice Address - Country:US
Practice Address - Phone:719-867-7800
Practice Address - Fax:719-867-7899
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO584237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA101444Medicare PIN