Provider Demographics
NPI:1033328166
Name:KOTRBA, AIMEE NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:NICOLE
Last Name:KOTRBA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:NICOLE
Other - Last Name:RUSTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10524 GRAND RIVER RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9597
Mailing Address - Country:US
Mailing Address - Phone:810-225-3417
Mailing Address - Fax:
Practice Address - Street 1:10524 GRAND RIVER RD
Practice Address - Street 2:STE. 100
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9597
Practice Address - Country:US
Practice Address - Phone:810-225-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012948103TC0700X
MI6301013685103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical