Provider Demographics
NPI:1326571522
Name:WELVAERT-KOCH, JENNIFER (MSED, LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WELVAERT-KOCH
Suffix:
Gender:F
Credentials:MSED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 44TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-7189
Mailing Address - Country:US
Mailing Address - Phone:309-788-9581
Mailing Address - Fax:309-786-3856
Practice Address - Street 1:4703 44TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7189
Practice Address - Country:US
Practice Address - Phone:309-788-9581
Practice Address - Fax:309-786-3856
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010882101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional