Individual ProviderJohnathan KoelschSocial WorkerBehavioral Health & Social Service ProvidersPractice Address1675 Curlew Dr, Ammon, ID 83406-4850(208) 523-5319PECOS EnrollmentBased on the most recent information from CMS, provider Johnathan Koelsch is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1326409913Provider TypeIndividualFull NameKoelsch, JohnathanCredentialLMSWGenderMaleSole ProprietorYesEnumeration Date3/10/2016Last Updated8/9/2023Contact InformationPractice LocationPractice Address1675 Curlew Dr, Ammon, ID 83406-4850Phone(208) 523-5319Fax(208) 523-5627Mailing LocationMailing AddressPO Box 2106, Idaho Falls, ID 83403-2106Phone(208) 523-5319Fax(208) 523-5627Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseLCSW-38371IdahoCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseLMSW-34382Idaho