Provider Demographics
NPI:1841972692
Name:KOEBERLEIN, MAKALAH CHRISTINE (MS)
Entity type:Individual
Prefix:
First Name:MAKALAH
Middle Name:CHRISTINE
Last Name:KOEBERLEIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 COUNTY ROAD 1400 EAST
Mailing Address - Street 2:
Mailing Address - City:TOLONO
Mailing Address - State:IL
Mailing Address - Zip Code:61880
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 DEVONSHIRE DR.
Practice Address - Street 2:SUITE B16-B18
Practice Address - City:CHAMPAGIN
Practice Address - State:IL
Practice Address - Zip Code:61820-7328
Practice Address - Country:US
Practice Address - Phone:217-531-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health