Individual
JENNIFER KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., CCC-SLP
Contact information
Practice address
3070 RITA WAY SE, SMYRNA, GA 30080-4179
(770) 365-9465
Mailing address
3070 RITA WAY SE, SMYRNA, GA 30080-4179
(770) 365-9465
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005448
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0977017A
—
GA
05
—
0977017B
—
GA
Enumeration date
07/04/2006
Last updated
08/13/2007
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