Provider Demographics
NPI:1235172032
Name:KOTTMANN, DEBRA (MS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:KOTTMANN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-3201
Mailing Address - Country:US
Mailing Address - Phone:402-558-3856
Mailing Address - Fax:402-558-3039
Practice Address - Street 1:319 S 17TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1911
Practice Address - Country:US
Practice Address - Phone:402-558-3856
Practice Address - Fax:402-558-3039
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025312900Medicaid