Healthcare Provider Details

I. General information

NPI: 1861802670
Provider Name (Legal Business Name): ALYSHA JEAN OSTENDORF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSHA JEAN FERGUSON CSW

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 U.S. 31 W BYPASS #12
BOWLING GEEN KY
42101
US

IV. Provider business mailing address

2858 HARVEY ROBERTSON RD
WOODBURN KY
42170-9649
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-0120
  • Fax:
Mailing address:
  • Phone: 270-320-8598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3999
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: