Provider Demographics
NPI:1023534872
Name:KOCH, MONICA J (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:J
Last Name:KOCH
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6535 MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62245-2503
Mailing Address - Country:US
Mailing Address - Phone:618-792-6529
Mailing Address - Fax:
Practice Address - Street 1:777 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-1376
Practice Address - Country:US
Practice Address - Phone:618-526-7128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist