Healthcare Provider Details

I. General information

NPI: 1689539983
Provider Name (Legal Business Name): ROSALEA BOTKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W SUPERIOR ST
DULUTH MN
55802-1938
US

IV. Provider business mailing address

607 N LAKE AVE
DULUTH MN
55806-2528
US

V. Phone/Fax

Practice location:
  • Phone: 715-661-3619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: