| Doctor Name: | ELLIE LYNN KOEHN |
| NPI Number: | 1275979718 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LMSW |
| License Number: | 6801091461 |
| Business Practice Address: | 1375 R Dale Wertz Dr Bad Axe, MI - 484131365 |
| Business Phone Number: | 9892699293 |
| Business Fax Number: | 9892697544 |
| Mailing Address: | 1375 R Dale Wertz Dr, BAD AXE |
| State: | MI |
| Postal Code: | 484131365 |
| Phone Number: | 9892699293 |
| Fax Number: | 9892697544 |
| NPI Enumeration Date: | 05/10/2013 |
| NPI Last Update Date: | 02/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 6801091461 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |