Provider Demographics
NPI:1437437290
Name:OTTOFY, KATHERINE DEANNE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DEANNE
Last Name:OTTOFY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:DEANNE
Other - Last Name:HETZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:302 CAMPUSVIEW DR STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7506
Mailing Address - Country:US
Mailing Address - Phone:573-328-2288
Mailing Address - Fax:
Practice Address - Street 1:302 CAMPUSVIEW DR STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7506
Practice Address - Country:US
Practice Address - Phone:573-328-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090012691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496516907Medicaid