Provider Demographics
NPI:1063182327
Name:OTTE, NATALIE JEAN (PHD, LP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:JEAN
Last Name:OTTE
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:JEAN
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, DLLP
Mailing Address - Street 1:165 GLEN EAGLE DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1183
Mailing Address - Country:US
Mailing Address - Phone:248-660-7873
Mailing Address - Fax:
Practice Address - Street 1:1000 MONROE AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1455
Practice Address - Country:US
Practice Address - Phone:248-660-7873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301019172103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical