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General NPI Number Information
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NPI Number | 1124882360
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Entity Type | Individual
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Provider Name | MRS. HALEY POTTKOTTER
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Gender | Female
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Dates
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Enumeration Date | 02/08/2024
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 4 EAGLE DR STE A
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City | MINSTER
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State | OH
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Zip | 45865-9714
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Country | US
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Telephone | 419-628-6156
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Fax |
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Provider Business Mailing Address
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Address Line | 4 EAGLE DR STE A
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City | MINSTER
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State | OH
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Zip | 45865-9714
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Country | US
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Telephone | 419-628-6156
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | M.2400304
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License Number State | OH
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