Healthcare Provider Details

I. General information

NPI: 1386868560
Provider Name (Legal Business Name): KAREN A KOCH PSYD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S MICHIGAN AVE
CHICAGO IL
60603-6191
US

IV. Provider business mailing address

11548 TEA TREE LN
FRANKFORT IL
60423-5103
US

V. Phone/Fax

Practice location:
  • Phone: 312-261-3464
  • Fax: 312-261-3024
Mailing address:
  • Phone: 815-806-8839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: