Jessica Koluch

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

0014118 Issued in WI

Practice address

N11893 12TH Ave
Necedah, WI 54646-7528

Phone

(608) 548-2342

NPI assigned

Oct 1, 2012

Last updated

Oct 1, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349049600000",
    "number": "1245581289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N11893 12TH AVE",
            "city": "NECEDAH",
            "state": "WI",
            "postal_code": "546467528",
            "telephone_number": "608-548-2342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N11893 12TH AVE",
            "city": "NECEDAH",
            "state": "WI",
            "postal_code": "546467528",
            "telephone_number": "608-548-2342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLUCH",
        "first_name": "JESSICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-01",
        "last_updated": "2012-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "WI",
            "license": "0014118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Health Worker in Necedah, WI
• Providers in Necedah, WI by specialty
• Community Health Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.