Healthcare Provider Details

I. General information

NPI: 1477245827
Provider Name (Legal Business Name): MARIAH KOTTKE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 24TH AVE S STE 400
MINNEAPOLIS MN
55454-1517
US

IV. Provider business mailing address

1000 E 23RD ST STE 360
SIOUX FALLS SD
57105-2140
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-1609
  • Fax:
Mailing address:
  • Phone: 605-504-4363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: