Healthcare Provider Details

I. General information

NPI: 1275924037
Provider Name (Legal Business Name): NANCY JEANNE KOTWICKI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W CHISHOLM ST
ALPENA MI
49707-1401
US

IV. Provider business mailing address

1501 W CHISHOLM ST
ALPENA MI
49707-1401
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-7359
  • Fax:
Mailing address:
  • Phone: 989-356-7359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095924
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: