Provider Demographics
NPI:1366260887
Name:KOTTKE, JENNIFER JONES (FDNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JONES
Last Name:KOTTKE
Suffix:
Gender:F
Credentials:FDNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:160 TERRACE ST
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1845
Practice Address - Country:US
Practice Address - Phone:201-385-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach