Provider Demographics
NPI:1417281072
Name:OSTERHOUT, REBECCA ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ELLEN
Last Name:OSTERHOUT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 OAK VALLEY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9118
Mailing Address - Country:US
Mailing Address - Phone:607-725-6870
Mailing Address - Fax:
Practice Address - Street 1:2395 OAK VALLEY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9118
Practice Address - Country:US
Practice Address - Phone:607-725-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH12447OtherBCBSM PIN