Provider Demographics
NPI:1275682304
Name:KOCH, KRISTIN RACHEL (AU D)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:RACHEL
Last Name:KOCH
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2297 SEMINOLE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8300
Mailing Address - Country:US
Mailing Address - Phone:434-227-4100
Mailing Address - Fax:434-299-8892
Practice Address - Street 1:2297 SEMINOLE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8300
Practice Address - Country:US
Practice Address - Phone:434-227-4100
Practice Address - Fax:434-326-4532
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001289231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist