Individual
JESSICA MARIE KOTSAKIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 S 76TH ST, MILWAUKEE, WI 53214-1599
(414) 453-1400
(414) 453-2538
Mailing address
1885 LONE OAK CIR W, BROOKFIELD, WI 53045-5017
(262) 894-0742
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871266072
—
WI
Enumeration date
07/26/2021
Last updated
09/02/2021
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