Mr Gerard W Kottenbrock, LICSW LAC is a
Social Worker - Clinical based in Fargo, North Dakota. Mr Gerard W Kottenbrock is licensed to practice in North Dakota (license number LICSW1832) and his current practice location is
510 4th St S, Fargo, North Dakota. He can be reached at his office (for appointments etc.) via phone at
(701) 476-7240.
NPI number for Mr Gerard W Kottenbrock is 1528161189 and his current mailing address is 510 4th St S, Fargo, North Dakota. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1528161189.
Healthcare Provider's Profile
| Full Name | Mr Gerard W Kottenbrock |
|---|
| Gender | Male |
|---|
| Speciality | Social Worker - Clinical |
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| Location | 510 4th St S, Fargo, North Dakota |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1528161189
- Provider Enumeration Date: 09/07/2006
- Last Update Date: 07/08/2007
Medical Identifiers
Medical identifiers for Mr Gerard W Kottenbrock such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1528161189 | NPI | - | NPPES |
| 19120 | Medicaid | ND | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 1540 (North Dakota) | Primary |
| 1041C0700X | Social Worker - Clinical | LICSW1832 (North Dakota) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Gerard W Kottenbrock is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Gerard W Kottenbrock, LICSW LAC
510 4th St S,
Fargo, ND 58103
Ph: (701) 476-7240 | Mr Gerard W Kottenbrock, LICSW LAC
510 4th St S,
Fargo, ND 58103
Ph: (701) 476-7240 |
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