Healthcare Provider Details

I. General information

NPI: 1174119424
Provider Name (Legal Business Name): LINDSEY KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6415 FAIR OAKS AVE
CINCINNATI OH
45237-4509
US

IV. Provider business mailing address

6415 FAIR OAKS AVE
CINCINNATI OH
45237-4509
US

V. Phone/Fax

Practice location:
  • Phone: 598-512-5392
  • Fax:
Mailing address:
  • Phone: 598-512-5392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2405354
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: