Individual
DR. MICHELLE JEANNE BOTKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
1560 BEAM AVE STE 101, MAPLEWOOD, MN 55109-1191
(651) 777-7837
(651) 777-8754
Mailing address
8800 SE SUNNYSIDE RD STE 300N, CLACKAMAS, OR 97015-5703
(281) 286-2999
(612) 607-4893
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
6249
MN
237600000X
Audiologist-Hearing Aid Fitter
—
MN
237700000X
Hearing Instrument Specialist
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
640000549
MEDICARE
MN
Enumeration date
03/17/2007
Last updated
01/12/2018
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