Individual
STACEY ELAINE KOEHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
5900 METRO DR, BALTIMORE, MD 21215-3207
(410) 318-6780
(410) 318-6759
Mailing address
5900 METRO DR, BALTIMORE, MD 21215-3207
(410) 318-6780
(410) 318-6759
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
03327
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
621028-01
CAREFIRST BCBS
MD
01
—
621028-02
CAREFIRST BCBS
MD
01
—
621028-03
CAREFIRST BCBS
MD
01
—
J175-0011
CAREFIRST BCBS
DC
Enumeration date
12/03/2007
Last updated
12/03/2007
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