Healthcare Provider Details

I. General information

NPI: 1215444567
Provider Name (Legal Business Name): TIFFANY JANE KOCHER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 E DUBLIN GRANVILLE RD STE 290
COLUMBUS OH
43229-3245
US

IV. Provider business mailing address

275 MARTINEL DR
KENT OH
44240-4380
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 330-673-6446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1700246
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: