Provider Demographics
NPI:1558098418
Name:KOCH, JAMIE ANNE (AUD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANNE
Last Name:KOCH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4886 COUNTY ROAD 23
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-8412
Mailing Address - Country:US
Mailing Address - Phone:303-621-4189
Mailing Address - Fax:
Practice Address - Street 1:9403 CROWN CREST BLVD STE 300ENT
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8882
Practice Address - Country:US
Practice Address - Phone:720-274-2544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1153231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist