Provider Demographics
NPI:1912321639
Name:KONITZER, NANCY
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:KONITZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6399 FOUNTAINS BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-5704
Mailing Address - Country:US
Mailing Address - Phone:513-675-7396
Mailing Address - Fax:
Practice Address - Street 1:7480 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9619
Practice Address - Country:US
Practice Address - Phone:513-755-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 3740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist