Healthcare Provider Details

I. General information

NPI: 1619487774
Provider Name (Legal Business Name): DEVON OSTRANDER LSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 PROSPECT AVE
CARO MI
48723-9288
US

IV. Provider business mailing address

323 N STATE ST
CARO MI
48723-1537
US

V. Phone/Fax

Practice location:
  • Phone: 989-673-6191
  • Fax: 989-672-3170
Mailing address:
  • Phone: 989-673-6191
  • Fax: 989-672-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101003657
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: