=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104020189
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAY WICKETT OSTENSEN PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1278 GLENNEYRE PSYCHOLOGY CENTER #D
-----------------------------------------------------
City | LAGUNA BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-494-5460
-----------------------------------------------------
Fax | 949-209-8777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1278 GLENNEYRE SUITE #22
-----------------------------------------------------
City | LAGUNA BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-494-5460
-----------------------------------------------------
Fax | 949-209-8777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 6951
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC2200X
-----------------------------------------------------
Taxonomy Name | Clinical Child & Adolescent Psychologist
-----------------------------------------------------
License Number | 6951
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------