Healthcare Provider Details

I. General information

NPI: 1477160497
Provider Name (Legal Business Name): ERIN KAY KOTKOWSKI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8224 MENTOR AVE STE 208
MENTOR OH
44060-5743
US

IV. Provider business mailing address

8224 MENTOR AVE STE 208
MENTOR OH
44060-5743
US

V. Phone/Fax

Practice location:
  • Phone: 440-392-2222
  • Fax: 440-565-2349
Mailing address:
  • Phone: 440-392-2222
  • Fax: 440-565-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.08078
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019199
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: