Doctor Name: | POLLY A KOCH |
NPI Number: | 1114171048 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 114678 |
Business Practice Address: | 324 Liberty Street Delta, MO - 63744 |
Business Phone Number: | 5737942500 |
Business Fax Number: | 5737942504 |
Mailing Address: | Po Box 787, DELTA |
State: | MO |
Postal Code: | 637440787 |
Phone Number: | 5737942500 |
Fax Number: | 5737942504 |
NPI Enumeration Date: | 11/05/2008 |
NPI Last Update Date: | 11/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 114678 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |