Active NPI
Brenda Joy Otto, LP MN BD OF PSYCHOLO
- Psychologist
- Rochester, MN
National Provider Identifier
1265582340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP2719
- Practice address
- 2116 SE Campus Drive
Olmsted County Community Services
Rochester, MN 55904 - Phone
- (507) 285-7052
- Fax
- (507) 287-2371
- NPI assigned
- Jan 11, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP2719 | MN | Primary |
Addresses
Primary practice location
2116 SE Campus Drive
Olmsted County Community Services
Rochester, MN 55904
Mailing address
2116 SE Campus Drive
Olmsted County Community Services
Rochester, MN 55904
Phone (507) 285-7052
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 |
|---|---|---|---|
| LP2719 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265582340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2116 SE CAMPUS DRIVE",
"address_2": "OLMSTED COUNTY COMMUNITY SERVICES",
"city": "ROCHESTER",
"state": "MN",
"postal_code": "55904",
"telephone_number": "507-285-7052",
"fax_number": "507-287-2371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2116 SE CAMPUS DRIVE",
"address_2": "OLMSTED COUNTY COMMUNITY SERVICES",
"city": "ROCHESTER",
"state": "MN",
"postal_code": "55904",
"telephone_number": "507-285-7052",
"fax_number": "507-287-2371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTTO",
"first_name": "BRENDA",
"middle_name": "JOY",
"name_prefix": "Ms.",
"credential": "LP MN BD OF PSYCHOLO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP2719",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.