Healthcare Provider Details

I. General information

NPI: 1962214213
Provider Name (Legal Business Name): ELIZABETH KOCH CD,(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 INDIAN AVE
AURORA IL
60505-3137
US

IV. Provider business mailing address

1400 INDIAN AVE
AURORA IL
60505-3137
US

V. Phone/Fax

Practice location:
  • Phone: 630-892-4355
  • Fax:
Mailing address:
  • Phone: 630-892-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: