Provider Demographics
NPI:1841203742
Name:KOEHNEMANN, NEDA C (PHD)
Entity Type:Individual
Prefix:
First Name:NEDA
Middle Name:C
Last Name:KOEHNEMANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 JAZZ DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4906
Mailing Address - Country:US
Mailing Address - Phone:850-522-9719
Mailing Address - Fax:850-522-9718
Practice Address - Street 1:105 JAZZ DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4906
Practice Address - Country:US
Practice Address - Phone:850-522-9719
Practice Address - Fax:850-522-9718
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5444103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59895OtherBLUE CROSS BLUE SHIELD
FL59895OtherBLUE CROSS BLUE SHIELD