Provider Demographics
NPI:1396122503
Name:CAROL JO OTTER LADD PSYCHOTHERAPY AND CONSULTING LLC
Entity type:Organization
Organization Name:CAROL JO OTTER LADD PSYCHOTHERAPY AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LICSW, LSSW
Authorized Official - Phone:612-554-8560
Mailing Address - Street 1:8317 PILLSBURY AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2241
Mailing Address - Country:US
Mailing Address - Phone:612-554-8560
Mailing Address - Fax:
Practice Address - Street 1:8317 PILLSBURY AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2241
Practice Address - Country:US
Practice Address - Phone:612-554-8560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty