Provider Demographics
NPI:1699296780
Name:KOSCHAK, HANNAH JOY (RD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:JOY
Last Name:KOSCHAK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S8859 COTTONWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-2331
Mailing Address - Country:US
Mailing Address - Phone:608-515-3882
Mailing Address - Fax:
Practice Address - Street 1:S8859 COTTONWOOD CIR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2331
Practice Address - Country:US
Practice Address - Phone:608-515-3882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2875-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered