Provider Demographics
NPI:1720239791
Name:OTTERNESS, NANCY LYNN (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LYNN
Last Name:OTTERNESS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 SINGLETREE LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7919
Mailing Address - Country:US
Mailing Address - Phone:952-927-4866
Mailing Address - Fax:
Practice Address - Street 1:12100 SINGLETREE LN
Practice Address - Street 2:SUITE 105
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7919
Practice Address - Country:US
Practice Address - Phone:952-927-4866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN89301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical