Doctor Name: | JEREMY R KOEHL |
NPI Number: | 1972714053 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSSW, LCSW,CADCIII |
License Number: | 10748 |
Business Practice Address: | 21 West Omaha Street Washburn, WI - 548910036 |
Business Phone Number: | 7153730160 |
Business Fax Number: | 7153730162 |
Mailing Address: | 21 West Omaha Street, WASHBURN |
State: | WI |
Postal Code: | 548910036 |
Phone Number: | 7153730160 |
Fax Number: | 7153730162 |
NPI Enumeration Date: | 05/24/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 10748 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |