Provider Demographics
NPI:1316582091
Name:EWA OSTOJA LLC
Entity Type:Organization
Organization Name:EWA OSTOJA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EWA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTOJA-STARZEWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-214-5574
Mailing Address - Street 1:2424 PINE NEEDLE CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8585
Mailing Address - Country:US
Mailing Address - Phone:979-214-5574
Mailing Address - Fax:970-797-1079
Practice Address - Street 1:149 W HARVARD ST STE 202
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2186
Practice Address - Country:US
Practice Address - Phone:970-214-5574
Practice Address - Fax:970-797-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1144383605OtherINDIVIDUAL NPI