Healthcare Provider Details

I. General information

NPI: 1962184465
Provider Name (Legal Business Name): ABIGAIL K KONECKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 FOUNTAINS PKWY STE 201
FAIRVIEW HEIGHTS IL
62208-2170
US

IV. Provider business mailing address

7500 SAN FELIPE ST STE 990
HOUSTON TX
77063
US

V. Phone/Fax

Practice location:
  • Phone: 618-515-1441
  • Fax: 618-551-4711
Mailing address:
  • Phone: 281-826-3382
  • Fax: 425-491-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: