Healthcare Provider Details

I. General information

NPI: 1063182327
Provider Name (Legal Business Name): NATALIE JEAN OTTE PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE JEAN STEVENSON PHD, DLLP

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONROE AVE NW
GRAND RAPIDS MI
49503-1455
US

IV. Provider business mailing address

165 GLEN EAGLE DR NE
ROCKFORD MI
49341-1183
US

V. Phone/Fax

Practice location:
  • Phone: 248-660-7873
  • Fax:
Mailing address:
  • Phone: 248-660-7873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019172
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: