Healthcare Provider Details

I. General information

NPI: 1306915632
Provider Name (Legal Business Name): DIANE LEE OSTEBEE MACP LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HERMAN AVE
ZION IL
60099
US

IV. Provider business mailing address

1374 ALGONQUIN RD
DES PLAINES IL
60016
US

V. Phone/Fax

Practice location:
  • Phone: 847-401-2016
  • Fax: 847-296-5229
Mailing address:
  • Phone: 847-401-2016
  • Fax: 847-296-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: