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NPI Code Detail

MEDICARE: MS. SUZETTE KATHRYN KOEBLER MS, LPC

MEDICARE:  MS. SUZETTE KATHRYN KOEBLER  MS, LPC
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
1101YM0800XMental Health Counselor2839-125WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821053943
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUZETTE KATHRYN KOEBLER MS, LPC
Provider Business Mailing Address
First Line : 1822 HOLLY DRIVE
Second Line :
City : JANESVILLE
State : WI
Zip : 53546
Country : US
Telephone Number : 608-563-0048
Fax Number :
Provider Business Practice Location Address
First Line : 1 SOUTH MAIN C/O GENESIS COUNSELING SERVICES
Second Line :
City : JANESVILLE
State : WI
Zip : 53547-8010
Country : US
Telephone Number : 608-757-0404
Fax Number : 608-757-2319
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 07/08/2007

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