Healthcare Provider Details

I. General information

NPI: 1699824300
Provider Name (Legal Business Name): GRETCHEN OLENE KOCH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 OREGON ST STE A-4
OSHKOSH WI
54902-7001
US

IV. Provider business mailing address

2211 OREGON ST STE A-4
OSHKOSH WI
54902-7001
US

V. Phone/Fax

Practice location:
  • Phone: 920-819-8943
  • Fax: 888-778-9931
Mailing address:
  • Phone: 920-819-8943
  • Fax: 888-778-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3186-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: