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General NPI Number Information
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NPI Number | 1609294685
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Entity Type | Individual
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Provider Name | ERIC KOENIG M.A., CCC-A
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Gender | Male
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 910 REALTOR AVE
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City | TEXARKANA
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State | AR
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Zip | 71854-1020
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Country | US
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Telephone | 800-863-7441
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Fax |
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Provider Business Mailing Address
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Address Line | 910 REALTOR AVE
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City | TEXARKANA
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State | AR
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Zip | 71854-1020
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Country | US
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Telephone | 800-863-7441
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | A-01306
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License Number State | OH
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