Individual
KOTATEE TAMBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LP, LICSW
Contact information
Practice address
2500 2ND ST NE APT 607, MINNEAPOLIS, MN 55418-3588
(651) 497-9483
Mailing address
PO BOX 977, OWATONNA, MN 55060-0977
(507) 446-0431
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP7120
MN
1041C0700X
Clinical Social Worker
21317
MN
Other
Enumeration date
05/05/2014
Last updated
11/04/2024
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