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General NPI Number Information
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NPI Number | 1902248396
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Entity Type | Organization
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Legal Business Name | RICHARD M OSTROM, PSY.D. LLC
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 8390 W GAGE BLVD SUITE # 213
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City | KENNEWICK
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State | WA
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Zip | 99336-8105
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Country | US
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Telephone | 509-783-0990
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Fax |
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Provider Business Mailing Address
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Address Line | 8390 W GAGE BLVD SUITE # 213
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City | KENNEWICK
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State | WA
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Zip | 99336-8105
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Country | US
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Telephone | 509-783-0990
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. RICHARD M OSTROM
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Credential | PSY.D.
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Telephone | 509-783-0990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2822
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License Number State | WA
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