Provider Demographics
NPI:1114702487
Name:KOKWAA
Entity Type:Organization
Organization Name:KOKWAA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:MARILYN
Authorized Official - Last Name:RONKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-705-3906
Mailing Address - Street 1:6144 HILLSIDE AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2474
Mailing Address - Country:US
Mailing Address - Phone:502-705-3906
Mailing Address - Fax:
Practice Address - Street 1:6144 HILLSIDE AVE STE 11
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2474
Practice Address - Country:US
Practice Address - Phone:502-705-3906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)