Provider Demographics
NPI:1659824563
Name:OTTO, CARLEEN E (BA)
Entity Type:Individual
Prefix:
First Name:CARLEEN
Middle Name:E
Last Name:OTTO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 NATIONS DR
Mailing Address - Street 2:SUITE 116
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-9164
Mailing Address - Country:US
Mailing Address - Phone:847-662-0945
Mailing Address - Fax:847-855-1609
Practice Address - Street 1:1790 NATIONS DR
Practice Address - Street 2:SUITE 116
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9164
Practice Address - Country:US
Practice Address - Phone:847-662-0945
Practice Address - Fax:847-855-1609
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor