Healthcare Provider Details

I. General information

NPI: 1801379771
Provider Name (Legal Business Name): ANGELA OSTING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3828 W TAYLOR ST
CHICAGO IL
60624-4027
US

IV. Provider business mailing address

3204 EAGLE WAY
CHICAGO IL
60678-1032
US

V. Phone/Fax

Practice location:
  • Phone: 773-826-1916
  • Fax: 773-826-2707
Mailing address:
  • Phone: 630-717-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.012501
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: