Provider Demographics
NPI:1457491110
Name:OTTESON, JAMES PAUL (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PAUL
Last Name:OTTESON
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3008
Mailing Address - Country:US
Mailing Address - Phone:507-446-0002
Mailing Address - Fax:507-451-8003
Practice Address - Street 1:209 E MILL ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3008
Practice Address - Country:US
Practice Address - Phone:507-446-0002
Practice Address - Fax:507-451-8003
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4284103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN048L8OTOtherBCBS
MNLP4284OtherLICENSED PSYCHOLOGIST