Provider Demographics
NPI:1679930945
Name:KONIG, KARLY
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:KONIG
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 1:816 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2917
Mailing Address - Country:US
Mailing Address - Phone:305-389-6422
Mailing Address - Fax:
Practice Address - Street 1:2833 EXECUTIVE PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3646
Practice Address - Country:US
Practice Address - Phone:954-353-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08061235Z00000X
FLSA16236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist