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General NPI Number Information
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NPI Number | 1215813571
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Entity Type | Individual
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Provider Name | AMELIA KOCH
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Gender |
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 8940 W 24TH ST
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City | NORTH RIVERSIDE
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State | IL
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Zip | 60546-1158
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Country | US
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Telephone | 708-447-8030
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Fax |
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Provider Business Mailing Address
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Address Line | 2702 N ASHLAND AVE UNIT 2
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City | CHICAGO
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State | IL
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Zip | 60614-1106
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 1351277
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License Number State | IL
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