Provider Demographics
NPI:1841002888
Name:OSTENDORF, ERICA RUTH (BCABA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:RUTH
Last Name:OSTENDORF
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N WHISTLING STRAITS AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6271
Mailing Address - Country:US
Mailing Address - Phone:479-586-9450
Mailing Address - Fax:
Practice Address - Street 1:8 WILSON FARM RD STE F
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-8200
Practice Address - Country:US
Practice Address - Phone:501-733-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0-25-15792106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst