Healthcare Provider Details

I. General information

NPI: 1538413752
Provider Name (Legal Business Name): KAYLA M OSTERMANN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAYLA M THOMPSON

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 SAEMANN AVE
SHEBOYGAN WI
53081-2342
US

IV. Provider business mailing address

3900 W BROWN DEER RD STE 200
BROWN DEER WI
53209-1220
US

V. Phone/Fax

Practice location:
  • Phone: 920-783-6633
  • Fax:
Mailing address:
  • Phone: 414-540-2170
  • Fax: 414-540-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5430-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number921-226
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number5430
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: