Provider Demographics
NPI:1306994793
Name:KOPPELMAN, ANN SIMON (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:SIMON
Last Name:KOPPELMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 XENIA AVE
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1874
Mailing Address - Country:US
Mailing Address - Phone:937-767-7044
Mailing Address - Fax:937-767-5066
Practice Address - Street 1:213 XENIA AVE
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1874
Practice Address - Country:US
Practice Address - Phone:937-767-7044
Practice Address - Fax:937-767-5066
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4319103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0817736Medicaid
OH0817736Medicaid