MEDICARE: KATIE COLVIN MOTTOLA LCSW

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	1041C0700X	Clinical Social Worker	9756-123	WI
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1639918675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE COLVIN MOTTOLA LCSW

Provider Business Mailing Address
First Line	:	2913 S DELAWARE AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2913 S DELAWARE AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2516
Country	:	US
Telephone Number	:	512-627-2497
Fax Number	:

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

Provider Enumeration Date	:	05/20/2024
Last Update Date	:	06/08/2024

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Directions to “ KATIE COLVIN MOTTOLA LCSW” Practice Location

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