Individual
DR. JENNIFER ELIZABETH KOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
2502 E EMPIRE ST STE C, BLOOMINGTON, IL 61704-3739
(309) 663-7220
Mailing address
PO BOX 604, BLOOMINGTON, IL 61702-0604
(309) 663-7220
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.007625
IL
Other
Enumeration date
02/11/2009
Last updated
06/11/2010
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