Provider Demographics
NPI:1487782728
Name:KOSCHMANN, ELIZABETH S (PHD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:KOSCHMANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:S
Other - Last Name:FELDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:311 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4114
Mailing Address - Country:US
Mailing Address - Phone:503-805-2434
Mailing Address - Fax:
Practice Address - Street 1:311 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-4114
Practice Address - Country:US
Practice Address - Phone:503-805-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014838103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist