Basic Information
| Provider Information | |||||||||
| NPI: | 1295036960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OSTERGREN | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | YUNGEN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1255 HANSEN AVE S | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973024062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035885352 | ||||||||
| FaxNumber: | 5035854990 | ||||||||
| Practice Location | |||||||||
| Address1: | 2421 LANCASTER DR NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973051220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035885352 | ||||||||
| FaxNumber: | 5035854990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2010 | ||||||||
| LastUpdateDate: | 05/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.