Individual
MS. ANDREA OTTERNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
555 W BROADWAY AVE STE 1AND2, FOREST LAKE, MN 55025-1175
(651) 777-5222
(651) 251-5279
Mailing address
555 WEST BROADWAY AVE SUITE 2, FOREST LAKE, MN 55025
(651) 777-5222
(651) 251-5279
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302520
MN
Other
Enumeration date
11/05/2015
Last updated
11/05/2015
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