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General NPI Number Information
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NPI Number | 1093631244
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Entity Type | Individual
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Provider Name | HANNAH JO VAN OTTERLOO LGSW
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Gender | Female
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | 1600 MADISON AVE STE 110
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City | MANKATO
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State | MN
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Zip | 56001-5820
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Country | US
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Telephone | 651-313-8080
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Fax | 651-925-0610
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Provider Business Mailing Address
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Address Line | 2182 EAGLE RIDGE DR
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City | NORTH MANKATO
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State | MN
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Zip | 56003-1232
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 32916
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License Number State | MN
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