Provider Demographics
NPI:1144008103
Name:OTTOSON, SEAN PHILLIP
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:PHILLIP
Last Name:OTTOSON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SEAN
Other - Middle Name:PHILLIP
Other - Last Name:OTTOSON-MCKEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5597 AISEK ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9522
Mailing Address - Country:US
Mailing Address - Phone:907-780-3044
Mailing Address - Fax:907-780-6083
Practice Address - Street 1:5594 AISEK STREET
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-780-3036
Practice Address - Fax:907-780-6083
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)