MEDICARE: ROSALEA BOTKA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1689539983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALEA BOTKA

Provider Business Mailing Address
First Line	:	607 N LAKE AVE
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55806-2528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 W SUPERIOR ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-1938
Country	:	US
Telephone Number	:	715-661-3619
Fax Number	:

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

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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Directions to “ ROSALEA BOTKA ” Practice Location

Language	Start Address	Practice Location

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