Provider Demographics
NPI:1003387580
Name:OSTERDAHL, THOMAS (CDP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:OSTERDAHL
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7935 LAKE BALLINGER WAY
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-9166
Mailing Address - Country:US
Mailing Address - Phone:425-412-2973
Mailing Address - Fax:425-672-6022
Practice Address - Street 1:7935 LAKE BALLINGER WAY
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9166
Practice Address - Country:US
Practice Address - Phone:425-412-2973
Practice Address - Fax:425-672-6022
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60725651101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty