Provider Demographics
NPI:1932447141
Name:KOCH, JULIE JONG
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:JONG
Last Name:KOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3036 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:651-925-0606
Practice Address - Street 1:730 E 38TH ST STE 102
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-5218
Practice Address - Country:US
Practice Address - Phone:612-964-7869
Practice Address - Fax:651-925-0606
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN188201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical