Provider Demographics
NPI:1386195634
Name:OSTRUM, SARAH (LSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:OSTRUM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:UPHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:816 FEATHERSTONE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6300
Mailing Address - Country:US
Mailing Address - Phone:815-227-0081
Mailing Address - Fax:815-387-5316
Practice Address - Street 1:816 FEATHERSTONE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6300
Practice Address - Country:US
Practice Address - Phone:815-227-0081
Practice Address - Fax:815-387-5316
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129856-121104100000X
IL150.015791104100000X
IL149.0204221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker