Gerard W Kottenbrock, LICSW LAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1540 Issued in ND

Practice address

510 4TH St S
Fargo, ND 58103

Phone

(701) 476-7240

Fax

(701) 476-7269

NPI assigned

Sep 7, 2006

Last updated

Sep 11, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Prairie St Johns

  • Psychiatric Hospital
  • Fargo, ND
  • NPI 1417901000
  NPD (past)
• PSJ Acquisition LLC

  dba Prairie St John's

  • Psychiatric Hospital
  • Fargo, ND
  • NPI 1679709802
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1528161189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 4TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "701-476-7240",
            "fax_number": "701-476-7269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 4TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "701-476-7240",
            "fax_number": "701-476-7269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTTENBROCK",
        "first_name": "GERARD",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "LICSW LAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ND",
            "license": "1540",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "LICSW1832",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19120",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordyn Ann Koski, LCSW
• Karen E Kostecki, CRNA
• Sara Tawiah Kotey
• Joleen T Koth, MS, NCC
• Suchita Kotnala, MBBS
• Craig R Kouba, MD
• Sammantha Jeane Kouba, DO
• Pelagia E Kouloumberis, MD
• Evgueni E Kouznetsov, M.D.
• Kelsey Jolene Kowalski, SLP

• Addiction (Substance Use Disorder) Counselor in Fargo, ND
• Providers in Fargo, ND by specialty
• Addiction (Substance Use Disorder) Counselor in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.