Provider Demographics
NPI:1033612742
Name:OSTROM, JEFFERY M
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:M
Last Name:OSTROM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6028
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95604-6028
Mailing Address - Country:US
Mailing Address - Phone:530-878-5166
Mailing Address - Fax:916-797-8979
Practice Address - Street 1:12183 LOCKSLEY LN STE 201
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2052
Practice Address - Country:US
Practice Address - Phone:530-878-5166
Practice Address - Fax:916-797-8979
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)