Healthcare Provider Details

I. General information

NPI: 1386288124
Provider Name (Legal Business Name): NANCY KOTTKE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 SCHROEDER RD
MADISON WI
53711-2401
US

IV. Provider business mailing address

6300 ENTERPRISE LN STE 301
MADISON WI
53719-1190
US

V. Phone/Fax

Practice location:
  • Phone: 608-270-1960
  • Fax: 608-270-1696
Mailing address:
  • Phone: 608-828-3636
  • Fax: 608-828-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number435
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number435-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: