Provider Demographics
NPI:1669116620
Name:PROKOTT, MARIAH (MSW)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:PROKOTT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2754 GREAT RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BOWLUS
Mailing Address - State:MN
Mailing Address - Zip Code:56314-2008
Mailing Address - Country:US
Mailing Address - Phone:320-630-1213
Mailing Address - Fax:
Practice Address - Street 1:101 DEHLER DR
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4407
Practice Address - Country:US
Practice Address - Phone:320-253-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical