Individual
JEREMY R KOEHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSSW, LCSW,CADCIII
Contact information
Practice address
21 WEST OMAHA STREET, WASHBURN, WI 54891-0036
(715) 373-0160
(715) 373-0162
Mailing address
21 WEST OMAHA STREET, WASHBURN, WI 54891-0036
(715) 373-0160
(715) 373-0162
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10748
WI
1041C0700X
Clinical Social Worker
2257-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39246100
—
WI
Enumeration date
05/24/2007
Last updated
09/11/2025
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