Healthcare Provider Details

I. General information

NPI: 1538550298
Provider Name (Legal Business Name): HEATHER KOCHEN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E MAIN ST
ST CHARLES IL
60174-1948
US

IV. Provider business mailing address

811 S JEFFERSON ST
BATAVIA IL
60510-3035
US

V. Phone/Fax

Practice location:
  • Phone: 630-587-3777
  • Fax:
Mailing address:
  • Phone: 630-715-1572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180009543
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: