Provider Demographics
NPI:1821053943
Name:KOEBLER, SUZETTE KATHRYN (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:KATHRYN
Last Name:KOEBLER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 HOLLY DRIVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546
Mailing Address - Country:US
Mailing Address - Phone:608-563-0048
Mailing Address - Fax:
Practice Address - Street 1:1 SOUTH MAIN C/O GENESIS COUNSELING SERVICES
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53547-8010
Practice Address - Country:US
Practice Address - Phone:608-757-0404
Practice Address - Fax:608-757-2319
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2839-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43552400Medicaid