Provider Demographics
NPI:1124867023
Name:OSTLUND, PHOEBE ELOISE (MSW)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:ELOISE
Last Name:OSTLUND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:PHOEBE
Other - Middle Name:
Other - Last Name:OSTLUND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHOEBE OSTLUND LLMSW
Mailing Address - Street 1:555 VICTORIA CT APT 6
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-2882
Mailing Address - Country:US
Mailing Address - Phone:269-352-3349
Mailing Address - Fax:
Practice Address - Street 1:2150 COLUMBIA AVE W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-2848
Practice Address - Country:US
Practice Address - Phone:269-397-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511183531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical