Healthcare Provider Details

I. General information

NPI: 1609121011
Provider Name (Legal Business Name): SHANNON K OSTERHOUDT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON CUNNINGHAM BA

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PROSPECT ST.
NASHUA NH
03060
US

IV. Provider business mailing address

7 PROSPECT ST.
NASHUA NH
03060
US

V. Phone/Fax

Practice location:
  • Phone: 603-889-6147
  • Fax: 603-594-9649
Mailing address:
  • Phone: 603-889-6147
  • Fax: 603-883-1568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW128334
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: