Provider Demographics
NPI:1861792046
Name:KONECNY, MONIQUE ELAINE (LAC)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ELAINE
Last Name:KONECNY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5348 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4398
Mailing Address - Country:US
Mailing Address - Phone:773-565-6511
Mailing Address - Fax:
Practice Address - Street 1:5348 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4398
Practice Address - Country:US
Practice Address - Phone:773-565-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000120A171100000X
IL198.000912171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist