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NPI Code Detail

MEDICARE: MRS. JILLYN ALICE OSTERGAARD CMHC

MEDICARE: MRS. JILLYN ALICE OSTERGAARD CMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor146626-6004UT

General Provider Information

NPI Number : 1609376821
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JILLYN ALICE OSTERGAARD CMHC
Provider Business Mailing Address
First Line : 1525 N 200 W
Second Line :
City : LOGAN
State : UT
Zip : 84341-2032
Country : US
Telephone Number : 435-752-8880
Fax Number : 435-752-8884
Provider Business Practice Location Address
First Line : 1525 N 200 W
Second Line :
City : LOGAN
State : UT
Zip : 84341-2032
Country : US
Telephone Number : 435-752-8880
Fax Number : 435-752-8884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2018
Last Update Date : 02/14/2018

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Directions to “ MRS. JILLYN ALICE OSTERGAARD CMHC” Practice Location

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