Provider Demographics
NPI:1932273158
Name:KONOPKO, SHERI M (MSCCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:SHERI
Middle Name:M
Last Name:KONOPKO
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 N. GRACE BOULAVARD
Mailing Address - Street 2:UNIT 106
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225
Mailing Address - Country:US
Mailing Address - Phone:203-654-6237
Mailing Address - Fax:
Practice Address - Street 1:3777 E HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2166
Practice Address - Country:US
Practice Address - Phone:480-507-1359
Practice Address - Fax:480-503-1487
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist