Healthcare Provider Details

I. General information

NPI: 1407913007
Provider Name (Legal Business Name): CHRISTINE DENISE KOHL MS COMM DISORDERS NS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W J WALTZ WAY
APACHE JUNCTION AZ
85120-0146
US

IV. Provider business mailing address

730 W J WALTZ WAY
APACHE JUNCTION AZ
85120-0146
US

V. Phone/Fax

Practice location:
  • Phone: 480-540-4183
  • Fax:
Mailing address:
  • Phone: 480-540-4183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP4098
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: