Healthcare Provider Details

I. General information

NPI: 1902695117
Provider Name (Legal Business Name): RACHAEL KAYE KOTTKE MSW, LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

1776 MARYLAND AVE E APT 305
SAINT PAUL MN
55106-2982
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-4397
  • Fax:
Mailing address:
  • Phone: 651-307-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number32316
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: