Provider Demographics
NPI:1760762967
Name:KOCH, SUSAN WENONAH (MS, CGC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WENONAH
Last Name:KOCH
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S COLLEGEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2998
Mailing Address - Country:US
Mailing Address - Phone:610-454-4717
Mailing Address - Fax:610-271-6807
Practice Address - Street 1:1201 S COLLEGEVILLE RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2998
Practice Address - Country:US
Practice Address - Phone:610-454-4717
Practice Address - Fax:610-271-6807
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS