Provider Demographics
NPI:1790122158
Name:KOCH, ALISON (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 S HARVARD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4629 S HARVARD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2948
Practice Address - Country:US
Practice Address - Phone:918-710-2370
Practice Address - Fax:918-398-7983
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200557240AMedicaid