MEDICARE: ZOTA DECONTEE KORTI

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
1	101YP2500X	Professional Counselor	0000000	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000000	OTHER	MN	BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1598352957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOTA DECONTEE KORTI

Provider Business Mailing Address
First Line	:	2800 FREEWAY BLVD STE 204
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-1751
Country	:	US
Telephone Number	:	763-412-1996
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 FREEWAY BLVD STE 204
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-1751
Country	:	US
Telephone Number	:	763-412-1996
Fax Number	:	763-292-5653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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Directions to “ ZOTA DECONTEE KORTI ” Practice Location

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