Provider Demographics
NPI:1902428535
Name:KOTT, CHARDYCE LYNNEA (MSW)
Entity Type:Individual
Prefix:
First Name:CHARDYCE
Middle Name:LYNNEA
Last Name:KOTT
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 1:117 FLINN ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2471
Mailing Address - Country:US
Mailing Address - Phone:202-996-0391
Mailing Address - Fax:630-566-4171
Practice Address - Street 1:117 FLINN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2471
Practice Address - Country:US
Practice Address - Phone:202-996-0391
Practice Address - Fax:630-566-4171
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker