Provider Demographics
NPI:1619393857
Name:KOCH, CAROL (EDD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:EDD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16251 W 77TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-3003
Mailing Address - Country:US
Mailing Address - Phone:816-234-3760
Mailing Address - Fax:816-234-3291
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3760
Practice Address - Fax:816-234-3291
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006027164235Z00000X
KS2466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist