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Individual
THERESA KOCH
Active
Individual
THERESA KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
4039-123
WI
163W00000X
Registered Nurse
Primary
68389-030
WI
Other
Enumeration date
07/18/2006
Last updated
09/11/2025
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