Healthcare Provider Details

I. General information

NPI: 1346815099
Provider Name (Legal Business Name): ELIZABETH OSTENDORF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 GALLEY RD
COLORADO SPRINGS CO
80915-3736
US

IV. Provider business mailing address

2120 E LA SALLE ST
COLORADO SPRINGS CO
80909-2218
US

V. Phone/Fax

Practice location:
  • Phone: 719-309-0119
  • Fax: 719-368-8399
Mailing address:
  • Phone: 719-466-4809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH MARY OSTENDORF
Title or Position: CEO
Credential:
Phone: 719-649-5037