Provider Demographics
NPI:1669592903
Name:KOCH, BETHANY ANN (SLP)
Entity type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:ANN
Last Name:KOCH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6818 ALBER AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129
Mailing Address - Country:US
Mailing Address - Phone:440-882-6343
Mailing Address - Fax:
Practice Address - Street 1:4511 ROCKSIDE RD
Practice Address - Street 2:#330 SUPPLEMENTAL HEALTH CARE
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131
Practice Address - Country:US
Practice Address - Phone:216-901-0400
Practice Address - Fax:216-901-0401
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist