Healthcare Provider Details

I. General information

NPI: 1174011704
Provider Name (Legal Business Name): MORGAN RENEE KOCH BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 E BROAD ST
COLUMBUS OH
43215-4004
US

IV. Provider business mailing address

431 EAST BROAD STREET
COLUMBUS OH
43215
US

V. Phone/Fax

Practice location:
  • Phone: 614-885-5020
  • Fax: 614-559-2801
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2107017
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: