Provider Demographics
NPI:1821325200
Name:OTTO, DIONNE MARIE (DOULA, LCCE, CLC)
Entity Type:Individual
Prefix:
First Name:DIONNE
Middle Name:MARIE
Last Name:OTTO
Suffix:
Gender:F
Credentials:DOULA, LCCE, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 COLTON AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3310
Mailing Address - Country:US
Mailing Address - Phone:309-706-9881
Mailing Address - Fax:
Practice Address - Street 1:304 COLTON AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3310
Practice Address - Country:US
Practice Address - Phone:309-706-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker