Provider Demographics
NPI:1336260397
Name:KOESTER, CAROL JEANNE
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JEANNE
Last Name:KOESTER
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 1:7498 E 1200TH AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-6628
Mailing Address - Country:US
Mailing Address - Phone:618-483-3038
Mailing Address - Fax:618-483-3038
Practice Address - Street 1:7498 E 1200TH AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-6628
Practice Address - Country:US
Practice Address - Phone:618-483-3038
Practice Address - Fax:618-483-3038
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist