Provider Demographics
NPI:1144620766
Name:KONKEL, KIRSTEN ALEXIS (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ALEXIS
Last Name:KONKEL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9313 EDENSBURY CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4137
Mailing Address - Country:US
Mailing Address - Phone:916-831-9494
Mailing Address - Fax:
Practice Address - Street 1:8788 ELK GROVE BLVD
Practice Address - Street 2:BLDG 3, SUITE 12I
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624
Practice Address - Country:US
Practice Address - Phone:916-467-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP24676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist