Provider Demographics
NPI:1386172070
Name:KOECH, WELDON KIPNGENO (LCSW)
Entity type:Individual
Prefix:
First Name:WELDON
Middle Name:KIPNGENO
Last Name:KOECH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 MALBEC CIR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-4614
Mailing Address - Country:US
Mailing Address - Phone:317-471-7176
Mailing Address - Fax:
Practice Address - Street 1:1324 MALBEC CIR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-4614
Practice Address - Country:US
Practice Address - Phone:317-471-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007826A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical