Provider Demographics
NPI:1669609053
Name:OTTENBREIT, DAWN MARIE (MA, LLP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:OTTENBREIT
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 N MAIN ST STE 318
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1250
Mailing Address - Country:US
Mailing Address - Phone:734-589-3732
Mailing Address - Fax:
Practice Address - Street 1:340 N MAIN ST STE 318
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1250
Practice Address - Country:US
Practice Address - Phone:734-589-3732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361004423103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling