Healthcare Provider Details

I. General information

NPI: 1316829708
Provider Name (Legal Business Name): ANGEL KOONTZ SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15802 N PARKVIEW PL
SURPRISE AZ
85374-7466
US

IV. Provider business mailing address

20808 N 27TH AVE APT 1070
PHOENIX AZ
85027-3230
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7000
  • Fax:
Mailing address:
  • Phone: 812-801-3159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP16448
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: