Provider Demographics
NPI:1386288124
Name:KOTTKE, NANCY (LCSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:KOTTKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 ENTERPRISE LN STE 301
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1190
Mailing Address - Country:US
Mailing Address - Phone:608-828-3636
Mailing Address - Fax:608-828-3637
Practice Address - Street 1:6506 SCHROEDER RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2401
Practice Address - Country:US
Practice Address - Phone:608-270-1960
Practice Address - Fax:608-270-1696
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI435101YM0800X
WI435-123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health