Individual
KELLY LYNN OTTAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
207 1ST ST, JACKSON, MI 49201-2102
(517) 998-4673
Mailing address
407 W HARRISON ST, WAKARUSA, IN 46573-9583
(226) 787-1217
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401018105
MI
Other
Enumeration date
03/04/2017
Last updated
10/16/2024
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