Provider Demographics
NPI:1154985075
Name:KOEHLER, DELILAH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:DELILAH
Middle Name:
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:DEEDEE
Other - Middle Name:
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:719 FREDRICK CT APT 7
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-3416
Mailing Address - Country:US
Mailing Address - Phone:715-851-3030
Mailing Address - Fax:
Practice Address - Street 1:719 FREDRICK CT APT 7
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-3416
Practice Address - Country:US
Practice Address - Phone:715-851-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist