Healthcare Provider Details

I. General information

NPI: 1609746395
Provider Name (Legal Business Name): CONTESSA ANNE KOTARSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TESSA KOTARSKI

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 W MADISON ST
CHICAGO IL
60602-4309
US

IV. Provider business mailing address

443 W WRIGHTWOOD AVE APT 414
CHICAGO IL
60614-2961
US

V. Phone/Fax

Practice location:
  • Phone: 920-391-9044
  • Fax:
Mailing address:
  • Phone: 920-391-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.008412
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: