Provider Demographics
NPI:1043230881
Name:OSTERMEIER, SALLY J (LCSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:J
Last Name:OSTERMEIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4639 NEWCOM AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5131
Mailing Address - Country:US
Mailing Address - Phone:865-588-2204
Mailing Address - Fax:865-588-2264
Practice Address - Street 1:4639 NEWCOM AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5131
Practice Address - Country:US
Practice Address - Phone:865-588-2204
Practice Address - Fax:865-588-2264
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3695506Medicaid
74372OtherBLUE CROSS BLUE SHIELD
TN3695506Medicaid