Healthcare Provider Details

I. General information

NPI: 1821816752
Provider Name (Legal Business Name): PATRICK KOCH MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 PENN AVE S STE 270
BLOOMINGTON MN
55431-1320
US

IV. Provider business mailing address

12301 WHITEWATER DR STE 101
MINNETONKA MN
55343-4157
US

V. Phone/Fax

Practice location:
  • Phone: 800-336-5973
  • Fax: 612-234-4689
Mailing address:
  • Phone: 952-999-6097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: