Provider Demographics
NPI:1174242721
Name:KOCH, EMILY BETH
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:BETH
Last Name:KOCH
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 1:2720 CRESTED BUTTE TRL
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-6666
Mailing Address - Country:US
Mailing Address - Phone:630-217-1187
Mailing Address - Fax:
Practice Address - Street 1:2272 95TH ST STE 305
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8944
Practice Address - Country:US
Practice Address - Phone:630-753-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional