Healthcare Provider Details

I. General information

NPI: 1417611989
Provider Name (Legal Business Name): KATELYN ROGOTZKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N RIVERFRONT DR STE 130
MANKATO MN
56001-3624
US

IV. Provider business mailing address

530 N RIVERFRONT DR STE 130
MANKATO MN
56001-3624
US

V. Phone/Fax

Practice location:
  • Phone: 507-218-0029
  • Fax:
Mailing address:
  • Phone: 507-218-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3250
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: