Provider Demographics
NPI:1184355562
Name:JENNIFER KOCH, PSY.D., PLLC
Entity type:Organization
Organization Name:JENNIFER KOCH, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:360-706-2674
Mailing Address - Street 1:111 TUMWATER BLVD SE STE C213
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6400
Mailing Address - Country:US
Mailing Address - Phone:360-706-2674
Mailing Address - Fax:360-634-3565
Practice Address - Street 1:111 TUMWATER BLVD SE STE C213
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6400
Practice Address - Country:US
Practice Address - Phone:360-706-2674
Practice Address - Fax:360-634-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty