Otto, Stacey

Otto, Stacey is an individual health care provider with primary practice located at 220 Washington Avenue , Oshkosh WI 54901. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Otto, Stacey can be contacted via phone (920) 236-4600.

Contact Information

Primary practice address
220 Washington Avenue Oshkosh WI 54901
Phone: (920) 236-4600
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 6910-123 Wisconsin

Profile Details

NPI number 1871651299
LBN Legal business name Otto, Stacey
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 5th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871651299 NPPES
Wisconsin MEDICAID 42156000
Wisconsin MEDICAID 42139300

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