Provider Demographics
NPI:1225670912
Name:OTTO, BARBARA A (MSSA, LSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:OTTO
Suffix:
Gender:F
Credentials:MSSA, LSW
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:A
Other - Last Name:CLEMENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3047 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9073
Mailing Address - Country:US
Mailing Address - Phone:937-631-6223
Mailing Address - Fax:
Practice Address - Street 1:3047 WILLOW RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-9073
Practice Address - Country:US
Practice Address - Phone:937-631-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1903857104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker