Provider Demographics
NPI:1255662193
Name:KOSTER, JANE A
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:KOSTER
Suffix:
Gender:F
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 71425
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-0425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:801-942-5955
Practice Address - Street 1:1301 CENTER ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1004
Practice Address - Country:US
Practice Address - Phone:515-243-5181
Practice Address - Fax:515-243-2760
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0072911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical