Healthcare Provider Details

I. General information

NPI: 1255120135
Provider Name (Legal Business Name): ASHLEE RENEA KOCH CDCA PRELIMINARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 GARFIELD AVE
LANCASTER OH
43130-2432
US

IV. Provider business mailing address

625 GARFIELD AVE
LANCASTER OH
43130-2432
US

V. Phone/Fax

Practice location:
  • Phone: 740-201-2778
  • Fax:
Mailing address:
  • Phone: 740-201-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number192396
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: