Healthcare Provider Details

I. General information

NPI: 1063359180
Provider Name (Legal Business Name): JESSICA KONIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 398
PINE ISLAND MN
55963-0398
US

IV. Provider business mailing address

305 7TH ST SW
ORONOCO MN
55960-1802
US

V. Phone/Fax

Practice location:
  • Phone: 507-356-8581
  • Fax:
Mailing address:
  • Phone: 507-367-4970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7659
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: