Healthcare Provider Details

I. General information

NPI: 1518368539
Provider Name (Legal Business Name): LAUREN KOCH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 08/03/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13126 W SUNSET HWY
AIRWAY HEIGHTS WA
99001
US

IV. Provider business mailing address

23237 E SETTLER DR
LIBERTY LAKE WA
99019-8524
US

V. Phone/Fax

Practice location:
  • Phone: 509-957-8290
  • Fax:
Mailing address:
  • Phone: 509-868-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: