MEDICARE: ELIZABETH KOCH CD,(DONA)

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	374J00000X	Doula		IL

General Provider Information

NPI Number	:	1962214213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH KOCH CD,(DONA)

Provider Business Mailing Address
First Line	:	1400 INDIAN AVE
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60505-3137
Country	:	US
Telephone Number	:	630-892-4355
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 INDIAN AVE
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60505-3137
Country	:	US
Telephone Number	:	630-892-4355
Fax Number	:

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

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	01/23/2025

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