MEDICARE: JO ELLEN OSTROW L.A.D.C.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	168-L	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	N/A	OTHER		N/A

General Provider Information

NPI Number	:	1447261102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO ELLEN OSTROW L.A.D.C.

Provider Business Mailing Address
First Line	:	1681 E FLAMINGO RD
Second Line	:	#2
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5274
Country	:	US
Telephone Number	:	702-650-0633
Fax Number	:	702-650-0642

Provider Business Practice Location Address
First Line	:	1681 E FLAMINGO RD
Second Line	:	#2
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5274
Country	:	US
Telephone Number	:	702-650-0633
Fax Number	:	702-650-0642

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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