Individual
ANITA C KONIKOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-A
Contact information
Practice address
6341 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4946
(763) 572-5710
(763) 586-5888
Mailing address
6401 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4341
(763) 572-5710
(763) 571-3008
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
5952
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5952
LICENSE NUMBER
MN
Enumeration date
07/10/2008
Last updated
07/10/2008
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