Provider Demographics
NPI:1295113124
Name:EHRENBERG-KOCH, AMANDA (HIS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:EHRENBERG-KOCH
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:EHRENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:2415 E 23RD AVE S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2407
Mailing Address - Country:US
Mailing Address - Phone:402-727-7866
Mailing Address - Fax:
Practice Address - Street 1:2415 E 23RD AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2407
Practice Address - Country:US
Practice Address - Phone:402-727-7866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE775237700000X
IA075886237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist