Provider Demographics
NPI:1992158174
Name:KOCH, MELINDA
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:KOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 S ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3448
Mailing Address - Country:US
Mailing Address - Phone:715-362-3711
Mailing Address - Fax:715-420-1686
Practice Address - Street 1:5404 ALDERSON ST
Practice Address - Street 2:STE 200
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-2293
Practice Address - Country:US
Practice Address - Phone:715-298-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1179-060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist