Provider Demographics
NPI:1194022970
Name:OSTOLOZAGA, ELIZABETH (CSW-PIP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:OSTOLOZAGA
Suffix:
Gender:F
Credentials:CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 W MAIN ST STE 303A6
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2437
Mailing Address - Country:US
Mailing Address - Phone:605-440-2287
Mailing Address - Fax:605-791-2086
Practice Address - Street 1:2525 W MAIN ST STE 303A6
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702
Practice Address - Country:US
Practice Address - Phone:605-440-2287
Practice Address - Fax:605-791-2086
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12682101YA0400X
NY079673104100000X
SD36341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2013208Medicaid