MEDICARE: NORMAN D OSTBLOOM LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	00782	IA

General Provider Information

NPI Number	:	1295760189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORMAN D OSTBLOOM LISW

Provider Business Mailing Address
First Line	:	125 S 3RD ST
Second Line	:
City	:	AMES
State	:	IA
Zip	:	50010-7042
Country	:	US
Telephone Number	:	515-232-5811
Fax Number	:	515-232-7491

Provider Business Practice Location Address
First Line	:	7272 WURZBACH ROAD
Second Line	:	SUITE 601
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4803
Country	:	US
Telephone Number	:	210-615-3428
Fax Number	:	210-593-9863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	04/25/2016

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