Individual
SHANNON M KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
350 N MAIN ST STE 220, CHELSEA, MI 48118-1370
(734) 433-5100
Mailing address
3884 5 MILE RD, SOUTH LYON, MI 48178-9697
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301017089
MI
103T00000X
Psychologist
6301017098
MI
103T00000X
Psychologist
Primary
6361007528
MI
Other
Enumeration date
06/04/2017
Last updated
11/17/2020
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