Individual
SUSAN T KOTOWICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, ACSW
Contact information
Practice address
2215 MAXWELL AVE, CHEYENNE, CHEYENNE, WY 82001-3849
(307) 634-6142
Mailing address
2215 MAXWELL AVE, CHEYENNE, CHEYENNE, WY 82001-3849
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
054
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
305303
BS OF WY
WY
Enumeration date
03/01/2006
Last updated
03/23/2009
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