Healthcare Provider Details

I. General information

NPI: 1902124597
Provider Name (Legal Business Name): MICHAEL BERNARD KOCHER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 GOLF RD SUITE 400
SKOKIE IL
60076-1224
US

IV. Provider business mailing address

4711 GOLF RD SUITE 400
SKOKIE IL
60076-1224
US

V. Phone/Fax

Practice location:
  • Phone: 773-504-6005
  • Fax: 847-570-4911
Mailing address:
  • Phone: 773-504-6005
  • Fax: 847-570-4911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149014104
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: