MEDICARE: KRISTY KONECKY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BACB438519	CO

General Provider Information

NPI Number	:	1225513310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY KONECKY

Provider Business Mailing Address
First Line	:	1650 MARBECK DR
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80550-6076
Country	:	US
Telephone Number	:	719-209-2862
Fax Number	:

Provider Business Practice Location Address
First Line	:	4650 ROYAL VISTA CIR
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80528-9321
Country	:	US
Telephone Number	:	970-818-0197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	01/11/2024

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Directions to “ KRISTY KONECKY ” Practice Location

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