Healthcare Provider Details

I. General information

NPI: 1386799112
Provider Name (Legal Business Name): RYAN L OSTGAARD MS, LPC-MH, CCDCIII
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W 22ND ST
SIOUX FALLS SD
57105-1702
US

IV. Provider business mailing address

520 W 22ND ST
SIOUX FALLS SD
57105-1702
US

V. Phone/Fax

Practice location:
  • Phone: 605-338-8003
  • Fax:
Mailing address:
  • Phone: 605-338-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number08111375
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-MH2187
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: