| NPI | 1659611341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY DAVID OTTERSON Owner/President 218-740-3061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 18201) |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2013-02-18 |