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General NPI Number Information
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NPI Number | 1770123291
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Entity Type | Individual
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Provider Name | JENNIFER M KOCH
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Gender | Female
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 450 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5000
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Country | US
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Telephone | 317-520-8200
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Fax | 317-520-8200
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Provider Business Mailing Address
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Address Line | 2785 SOM CENTER RD
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City | WILLOUGHBY HILLS
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State | OH
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Zip | 44094-6501
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Country | US
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Telephone | 216-278-0288
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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