Provider Demographics
NPI:1487964144
Name:KOCH, LINDSEY RAE (AUD)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:RAE
Last Name:KOCH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 S WESTERN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5047
Mailing Address - Country:US
Mailing Address - Phone:605-275-5545
Mailing Address - Fax:605-275-5546
Practice Address - Street 1:5124 S WESTERN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5047
Practice Address - Country:US
Practice Address - Phone:605-275-5545
Practice Address - Fax:605-275-5546
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD375A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00902392OtherRAILROAD MEDICARE
SD375AOtherSD LICENSE
S104555Medicare PIN