MEDICARE: ADRIENNE KOENIG M.S., CCC-SLP

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	235Z00000X	Speech-Language Pathologist	76855	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	76855-SP-SL	OTHER	MA	MASSACHUSETTS BOARD OF REGISTRATION FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
2	14154754	OTHER		AMERICAN SPEECH LANGUAGE HEARING ASSOCIATION

General Provider Information

NPI Number	:	1326505801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE KOENIG M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	10 BAY VIEW AVE APT 2
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-5704
Country	:	US
Telephone Number	:	978-793-3149
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 BAY VIEW AVE APT 2
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-5704
Country	:	US
Telephone Number	:
Fax Number	:

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

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	08/12/2021

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