Individual
CRYSTAL CHADDERTON KOENIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
910 N JEFFERSON ST, JACKSONVILLE, FL 32209-6810
(904) 360-7022
(904) 798-4545
Mailing address
11439 KABROON CT, JACKSONVILLE, FL 32246-6920
(904) 608-2848
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
FL
222Q00000X
Developmental Therapist
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
811897300
—
FL
Enumeration date
04/20/2007
Last updated
10/28/2013
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