Provider Demographics
NPI:1649334483
Name:OTTESON, BARBARA HELEN (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:HELEN
Last Name:OTTESON
Suffix:
Gender:F
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:507-446-9300
Mailing Address - Fax:
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:507-446-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN530GOTOtherBCBS
MN00869080Medicaid