Provider Demographics
NPI:1851659684
Name:KOEPPLIN, CHRISTINE (LMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KOEPPLIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-0039
Mailing Address - Country:US
Mailing Address - Phone:515-276-3473
Mailing Address - Fax:515-278-4329
Practice Address - Street 1:7085 NW BEAVER DR
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1249
Practice Address - Country:US
Practice Address - Phone:515-276-3473
Practice Address - Fax:515-278-4329
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06698104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker