Provider Demographics
NPI:1104935956
Name:OTTENFELD, JAN FLORENCE (MA, MSW)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:FLORENCE
Last Name:OTTENFELD
Suffix:
Gender:F
Credentials:MA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 OLYMPIA AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4033
Mailing Address - Country:US
Mailing Address - Phone:360-943-5968
Mailing Address - Fax:360-943-5982
Practice Address - Street 1:1005 OLYMPIA AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4033
Practice Address - Country:US
Practice Address - Phone:360-943-5968
Practice Address - Fax:360-943-5982
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000049281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW00004928OtherSTATE LISCENCE
WALW00004928OtherSTATE LISCENCE