Provider Demographics
NPI:1881872240
Name:OTTERSON, ELIZABETH ANN (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:OTTERSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:OTTERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19213 SOUNDVIEW DR NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-7878
Mailing Address - Country:US
Mailing Address - Phone:360-631-0949
Mailing Address - Fax:
Practice Address - Street 1:720 MAIN ST STE 224
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3830
Practice Address - Country:US
Practice Address - Phone:360-631-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000093441041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical