Provider Demographics
NPI:1386204790
Name:OSTROM, WHITNEY ERIN (MS, SST)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:ERIN
Last Name:OSTROM
Suffix:
Gender:F
Credentials:MS, SST
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:ERIN
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3838
Mailing Address - Country:US
Mailing Address - Phone:810-455-0102
Mailing Address - Fax:
Practice Address - Street 1:520 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3838
Practice Address - Country:US
Practice Address - Phone:810-455-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803086677104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker