Provider Demographics
NPI:1679591416
Name:OTTOSON, JOELLE KATHLEEN (MSW, LCSW, ICS,CSAC)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:KATHLEEN
Last Name:OTTOSON
Suffix:
Gender:F
Credentials:MSW, LCSW, ICS,CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N MILWAUKEE ST # 202
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5830
Mailing Address - Country:US
Mailing Address - Phone:262-646-8288
Mailing Address - Fax:
Practice Address - Street 1:240 N MILWAUKEE ST # 202
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5830
Practice Address - Country:US
Practice Address - Phone:262-646-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61451041C0700X
WI21521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39773900Medicaid