Healthcare Provider Details

I. General information

NPI: 1043879513
Provider Name (Legal Business Name): MATTHEW HOTEK LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E COURT AVE STE 200
DES MOINES IA
50309-2058
US

IV. Provider business mailing address

600 E COURT AVE STE 200
DES MOINES IA
50309-2058
US

V. Phone/Fax

Practice location:
  • Phone: 515-243-3525
  • Fax:
Mailing address:
  • Phone: 515-243-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number096247
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: