Healthcare Provider Details

I. General information

NPI: 1760762967
Provider Name (Legal Business Name): SUSAN WENONAH KOCH M.S., C.G.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S COLLEGEVILLE RD
COLLEGEVILLE PA
19426-2998
US

IV. Provider business mailing address

1201 S COLLEGEVILLE RD
COLLEGEVILLE PA
19426-2998
US

V. Phone/Fax

Practice location:
  • Phone: 610-454-4717
  • Fax: 610-271-6807
Mailing address:
  • Phone: 610-454-4717
  • Fax: 610-271-6807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: