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NPI Code Detail

MEDICARE: MRS. CATHY LYNN BAUER-KOTTENBROCK LICSW

MEDICARE: MRS. CATHY LYNN BAUER-KOTTENBROCK LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker3529ND

General Provider Information

NPI Number : 1558726083
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CATHY LYNN BAUER-KOTTENBROCK LICSW
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2400 32ND AVE S
Second Line :
City : FARGO
State : ND
Zip : 58103-5800
Country : US
Telephone Number : 701-234-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2015
Last Update Date : 01/13/2023

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