Provider Demographics
NPI:1144303918
Name:KOTTKE, CHERYL ANN (LMSW)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:KOTTKE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 N.E. EUCLID STREET
Mailing Address - Street 2:UNIT B
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501
Mailing Address - Country:US
Mailing Address - Phone:580-591-0593
Mailing Address - Fax:
Practice Address - Street 1:4301 MOW-WAY ROAD
Practice Address - Street 2:REYNOLDS ARMY COMMUNITY HOSPITAL(ATTN: MCUA-QC, )
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-6300
Practice Address - Country:US
Practice Address - Phone:580-458-2134
Practice Address - Fax:580-458-2314
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical