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General NPI Number Information
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NPI Number | 1649932302
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Entity Type | Individual
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Provider Name | JENNIFER OSTROM LADC, LPCC
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Gender | Female
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 1422 W LAKE ST STE 314
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2616
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Country | US
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Telephone | 612-445-0225
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Fax |
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Provider Business Mailing Address
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Address Line | 104 E 36TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-4538
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Country | US
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Telephone | 612-209-0046
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5363
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License Number State | MN
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