Healthcare Provider Details

I. General information

NPI: 1275663635
Provider Name (Legal Business Name): RENEE M. ROTTET LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 N 1000 W
LINTON IN
47441-5013
US

IV. Provider business mailing address

1185 N 1000 W
LINTON IN
47441-5282
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-4481
  • Fax: 844-658-7526
Mailing address:
  • Phone: 812-847-4481
  • Fax: 844-658-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004494A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: