Provider Demographics
NPI:1043737828
Name:OSTMAN, KIMBERLY MAE (MA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MAE
Last Name:OSTMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 LOUISIANA AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-4634
Mailing Address - Country:US
Mailing Address - Phone:763-458-0644
Mailing Address - Fax:
Practice Address - Street 1:265 RIVER ST N STE 109
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8266
Practice Address - Country:US
Practice Address - Phone:612-460-7252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health