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General NPI Number Information
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NPI Number | 1922737188
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Entity Type | Individual
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Provider Name | SHANA KOCH LPC
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Gender | Female
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Dates
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Enumeration Date | 06/05/2022
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 10850 W PARK PL STE 100
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City | MILWAUKEE
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State | WI
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Zip | 53224-3636
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Country | US
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Telephone | 262-999-3495
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 N SCOTTSDALE RD STE 2500
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-7630
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Country | US
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Telephone | 262-999-3495
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11741-125
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License Number State | WI
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