| Doctor Name: | JAMES JOHN KOTLEBA |
| NPI Number: | 1164729620 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LIC CLINICAL PSYCHOL |
| License Number: | 071002484 |
| Business Practice Address: | 745 S 8th St West Dundee, IL - 601183602 |
| Business Phone Number: | 8004287260 |
| Business Fax Number: | 8474287269 |
| Mailing Address: | 745- S 8th St, W. DUNDEE |
| State: | IL |
| Postal Code: | 60118 |
| Phone Number: | 8474287260 |
| Fax Number: | 8474287269 |
| NPI Enumeration Date: | 02/18/2011 |
| NPI Last Update Date: | 12/13/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 071002484 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |