Healthcare Provider Details

I. General information

NPI: 1366260887
Provider Name (Legal Business Name): JENNIFER JONES KOTTKE FDNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 TERRACE ST
HAWORTH NJ
07641-1845
US

IV. Provider business mailing address

120 GARFIELD ST
HAWORTH NJ
07641-1912
US

V. Phone/Fax

Practice location:
  • Phone: 201-385-0158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: