MEDICARE: DR. JEAN DUNMAN KOEHLER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0033	KY

General Provider Information

NPI Number	:	1730249889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN DUNMAN KOEHLER PH.D.

Provider Business Mailing Address
First Line	:	2703 SYCAMORE WOODS CT
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-6293
Country	:	US
Telephone Number	:	502-429-6311
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 BROWNSBORO PARK BLVD
Second Line	:	SUITE G
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-7201
Country	:	US
Telephone Number	:	502-897-2717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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