Provider Demographics
NPI:1932581923
Name:KOCH, KELLY LOUISE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LOUISE
Last Name:KOCH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LOUISE
Other - Last Name:VEYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 5631
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5631
Mailing Address - Country:US
Mailing Address - Phone:308-646-0002
Mailing Address - Fax:308-210-4121
Practice Address - Street 1:10909 MILL VALLEY RD STE 210
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-3950
Practice Address - Country:US
Practice Address - Phone:402-391-5002
Practice Address - Fax:402-343-1278
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist