Healthcare Provider Details

I. General information

NPI: 1891926846
Provider Name (Legal Business Name): NAOMI ROSE KONIKOFF M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 W OAKDALE AVE APT 411
CHICAGO IL
60657-5918
US

IV. Provider business mailing address

424 W OAKDALE AVE APT 411
CHICAGO IL
60657-5918
US

V. Phone/Fax

Practice location:
  • Phone: 612-644-7897
  • Fax:
Mailing address:
  • Phone: 612-644-7897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.010209
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: