Individual
JACOB OTTERNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1833 3RD AVE, ANOKA, MN 55303-2424
(763) 421-5535
Mailing address
1833 3RD AVE, ANOKA, MN 55303-2424
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/21/2016
Last updated
04/21/2016
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