Healthcare Provider Details

I. General information

NPI: 1801707682
Provider Name (Legal Business Name): HAILEY KOENIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 LEOPARD RD
PAOLI PA
19301-1549
US

IV. Provider business mailing address

2009 COVENTRY LN
GLEN MILLS PA
19342-9433
US

V. Phone/Fax

Practice location:
  • Phone: 610-647-6406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: