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Individual
PAUL JOHN OTTKE
Active
Individual
PAUL JOHN OTTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW-S
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-8964-SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000246009
ANTHEM PIN
—
01
—
11576328
CAQH #
—
Enumeration date
03/17/2006
Last updated
07/14/2015
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