Individual
ELIZABETH KONZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
602 VONDERBURG DR, STE 200, BRANDON, FL 33511-5900
(813) 653-1149
(813) 654-6644
Mailing address
602 VONDERBURG DR, SUITE 201, BRANDON, FL 33511-5900
(813) 653-1149
(813) 654-6644
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
SA10908
FL
235Z00000X
Speech-Language Pathologist
46001886A
IN
235Z00000X
Speech-Language Pathologist
Primary
SA10908
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003514300
—
FL
05
—
004059600
—
FL
01
—
01424158
AMERIGROUP
FL
Enumeration date
11/11/2008
Last updated
10/10/2011
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