Provider Demographics
NPI:1497183107
Name:OTTESEN, NATALIA (LPC)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:OTTESEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 W MORNINGSIDE CT
Mailing Address - Street 2:
Mailing Address - City:SAUKVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53080-2228
Mailing Address - Country:US
Mailing Address - Phone:262-268-0468
Mailing Address - Fax:
Practice Address - Street 1:122 GREEN BAY RD STE 3
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1679
Practice Address - Country:US
Practice Address - Phone:262-241-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4959-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional