Active NPI
Bethany Ann Koch, SLP
- Speech-Language Pathologist
- Independence, OH
National Provider Identifier
1669592903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 8402
- Practice address
- 4511 Rockside Rd
#330 Supplemental Health Care
Independence, OH 44131 - Phone
- (216) 901-0400
- Fax
- (216) 901-0401
- NPI assigned
- Mar 30, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 8402 | OH | Primary |
Addresses
Primary practice location
4511 Rockside Rd
#330 Supplemental Health Care
Independence, OH 44131
Mailing address
6818 Alber Ave
Parma, OH 44129
Phone (440) 882-6343
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8402 | OH | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669592903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6818 ALBER AVE",
"city": "PARMA",
"state": "OH",
"postal_code": "44129",
"telephone_number": "440-882-6343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4511 ROCKSIDE RD",
"address_2": "#330 SUPPLEMENTAL HEALTH CARE",
"city": "INDEPENDENCE",
"state": "OH",
"postal_code": "44131",
"telephone_number": "216-901-0400",
"fax_number": "216-901-0401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOCH",
"first_name": "BETHANY",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "8402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Independence, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.