Provider Demographics
NPI:1457526469
Name:KOACH, RHONDA L
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:KOACH
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 1:2700 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-1010
Mailing Address - Country:US
Mailing Address - Phone:815-758-2044
Mailing Address - Fax:
Practice Address - Street 1:2127 MIDLANDS CT
Practice Address - Street 2:SUITE 203
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3119
Practice Address - Country:US
Practice Address - Phone:815-758-8106
Practice Address - Fax:815-758-8108
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-004279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216367Medicare PIN