Provider Demographics
NPI:1831328665
Name:KOCHENDORFER, TRACI (PHD,PSYD, DD FPLC)
Entity type:Individual
Prefix:DR
First Name:TRACI
Middle Name:
Last Name:KOCHENDORFER
Suffix:
Gender:F
Credentials:PHD,PSYD, DD FPLC
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:K.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5440 DUNMORE DR STE 118
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1133
Mailing Address - Country:US
Mailing Address - Phone:937-848-0348
Mailing Address - Fax:
Practice Address - Street 1:5440 DUNMORE DR STE 118
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-1133
Practice Address - Country:US
Practice Address - Phone:937-848-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 133NN1002X, 174H00000X, 225A00000X, 171400000X
NC133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist