Provider Demographics
NPI:1255120135
Name:KOCH, ASHLEE RENEA (CDCA PRELIMINARY)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:RENEA
Last Name:KOCH
Suffix:
Gender:
Credentials:CDCA PRELIMINARY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2432
Mailing Address - Country:US
Mailing Address - Phone:740-201-2778
Mailing Address - Fax:
Practice Address - Street 1:625 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-2432
Practice Address - Country:US
Practice Address - Phone:740-201-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH192396101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)