Provider Demographics
NPI:1386818292
Name:KOCH, ANGELA MARIE HIGGINS (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE HIGGINS
Last Name:KOCH
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
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Mailing Address - Street 1:10339 N PINE SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-8829
Mailing Address - Country:US
Mailing Address - Phone:715-360-7482
Mailing Address - Fax:
Practice Address - Street 1:705 E TIMBER DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2859
Practice Address - Country:US
Practice Address - Phone:715-365-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1626-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42802700Medicaid
WI1626-154OtherWI STATE PROFESSIONAL SLP LICENSE