Healthcare Provider Details

I. General information

NPI: 1699502690
Provider Name (Legal Business Name): CHLOE KOEPPEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

600 UPTOWN BLVD UNIT 428
BROOKFIELD WI
53045-1370
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-3000
  • Fax:
Mailing address:
  • Phone: 414-416-4513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: