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NPI Code Detail

MEDICARE: JAN FLORENCE OTTENFELD MA, MSW

MEDICARE: JAN FLORENCE OTTENFELD MA, MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLW00004928WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LW00004928OTHERWASTATE LISCENCE

General Provider Information

NPI Number : 1104935956
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAN FLORENCE OTTENFELD MA, MSW
Provider Business Mailing Address
First Line : 1005 OLYMPIA AVE NE
Second Line :
City : OLYMPIA
State : WA
Zip : 98506-4033
Country : US
Telephone Number : 360-943-5968
Fax Number : 360-943-5982
Provider Business Practice Location Address
First Line : 1005 OLYMPIA AVE NE
Second Line :
City : OLYMPIA
State : WA
Zip : 98506-4033
Country : US
Telephone Number : 360-943-5968
Fax Number : 360-943-5982
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2006
Last Update Date : 07/08/2007

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