Provider Demographics
NPI:1154604346
Name:KOEHLER, ANN M (SLP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2736 CHADSWORTH LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTHPOINT
Mailing Address - State:NC
Mailing Address - Zip Code:28461
Mailing Address - Country:US
Mailing Address - Phone:315-806-1168
Mailing Address - Fax:
Practice Address - Street 1:1070 OLD OCEAN HIGHWAY
Practice Address - Street 2:UNIVERSAL HEALTHCARE BRUNSWICK
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422
Practice Address - Country:US
Practice Address - Phone:910-755-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5426-1235Z00000X
NC7354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist