Active NPI
Joanna Van Otterloo
- Professional Counselor
- Minnetonka, MN
National Provider Identifier
1154759801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- E.0500164-SUPV
- Practice address
- 3395 Plymouth Rd
Minnetonka, MN 55305-3765 - Phone
- (612) 503-1958
- NPI assigned
- Oct 16, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | E.0500164-SUPV | OH | Primary |
| Mental Health Counselor | 101YM0800X | 1262 | MN |
Addresses
Primary practice location
3395 Plymouth Rd
Minnetonka, MN 55305-3765
Mailing address
4123 Painted Sky TRL
Chaska, MN 55318-4004
Phone (513) 505-3786
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E.0500164-SUPV | OH | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1381881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790208000000",
"number": "1154759801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4123 PAINTED SKY TRL",
"city": "CHASKA",
"state": "MN",
"postal_code": "553184004",
"telephone_number": "513-505-3786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3395 PLYMOUTH RD",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553053765",
"telephone_number": "612-503-1958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN OTTERLOO",
"first_name": "JOANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-10-16",
"last_updated": "2026-09-24",
"certification_date": "2026-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "E.0500164-SUPV",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MN",
"license": "1262",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.