Provider Demographics
NPI:1053951020
Name:KOONS, BRANDY ROCHELLE (LSW)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:ROCHELLE
Last Name:KOONS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-8900
Mailing Address - Country:US
Mailing Address - Phone:502-938-4626
Mailing Address - Fax:
Practice Address - Street 1:9200 ROBIN RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-8900
Practice Address - Country:US
Practice Address - Phone:502-938-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3300858A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker