Provider Demographics
NPI:1164715256
Name:VOTROUBEK, KYLE A (MSW)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:A
Last Name:VOTROUBEK
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 WALFORD RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-9099
Mailing Address - Country:US
Mailing Address - Phone:319-573-2053
Mailing Address - Fax:
Practice Address - Street 1:3113 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-4524
Practice Address - Country:US
Practice Address - Phone:319-573-2053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical