Provider Demographics
NPI:1588081137
Name:KOEHLER, GROVER (M ED)
Entity type:Individual
Prefix:
First Name:GROVER
Middle Name:
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 KING ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-1326
Mailing Address - Country:US
Mailing Address - Phone:303-225-4194
Mailing Address - Fax:
Practice Address - Street 1:325 KING ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-1326
Practice Address - Country:US
Practice Address - Phone:303-225-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0009086171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator