Healthcare Provider Details

I. General information

NPI: 1194889352
Provider Name (Legal Business Name): OTTESON ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E MILL ST
OWATONNA MN
55060-3008
US

IV. Provider business mailing address

209 E MILL ST
OWATONNA MN
55060-3008
US

V. Phone/Fax

Practice location:
  • Phone: 507-446-0002
  • Fax: 507-451-8003
Mailing address:
  • Phone: 507-446-0002
  • Fax: 507-451-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP4284
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberLP4284
License Number StateMN

VIII. Authorized Official

Name: DR. JAMES PAUL OTTESON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D., LP
Phone: 507-446-0002