Active NPI
Courtney Ann Otteson, LSW
- Social Worker
- Saint Cloud, MN
National Provider Identifier
1578889184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 18899
- Practice address
- 519 2ND St N
Independent Lifestyles
St. Cloud, MN 56303 - Phone
- (320) 529-9000
- Fax
- (320) 529-0747
- NPI assigned
- Apr 8, 2010
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 18899 | MN | Primary |
Addresses
Primary practice location
519 2ND St N
Independent Lifestyles
St. Cloud, MN 56303
Mailing address
519 2ND Street N
Independent Lifestyles, Inc
St. Cloud, MN 56303
Phone (320) 529-9000
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 |
|---|---|---|---|
| 18899 | MN | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270684800000",
"number": "1578889184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "519 2ND STREET N",
"address_2": "INDEPENDENT LIFESTYLES, INC",
"city": "ST. CLOUD",
"state": "MN",
"postal_code": "56303",
"telephone_number": "320-529-9000",
"fax_number": "320-529-0747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "519 2ND ST N",
"address_2": "INDEPENDENT LIFESTYLES",
"city": "ST. CLOUD",
"state": "MN",
"postal_code": "56303",
"telephone_number": "320-529-9000",
"fax_number": "320-529-0747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTTESON",
"first_name": "COURTNEY",
"middle_name": "ANN",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-08",
"last_updated": "2010-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MN",
"license": "18899",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.