Basic Information
Provider Information | |||||||||
NPI: | 1700941457 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OSTROWSKI | ||||||||
FirstName: | MARGARET | ||||||||
MiddleName: | HELEN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS,PCC-S,REGPLAYTH-S | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4527 BLACKSTONE DRIVE EAST | ||||||||
Address2: |   | ||||||||
City: | MAURNEE | ||||||||
State: | OH | ||||||||
PostalCode: | 43537 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4193922245 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 741 SCHOLL RD | ||||||||
Address2: |   | ||||||||
City: | MANSFIELD | ||||||||
State: | OH | ||||||||
PostalCode: | 449071571 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4197742228 | ||||||||
FaxNumber: | 4197746882 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/23/2006 | ||||||||
LastUpdateDate: | 03/05/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/05/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | E.0007778-SUPV | OH | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101Y00000X | 6401011004 | MI | N |   | Behavioral Health & Social Service Providers | Counselor |   | 101YM0800X | 6401011004 | MI | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | E0007778 | OH | N |   | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
ID | Type | State | Issuer | Description | 11758178 | 01 |   | CAQH | OTHER |