Provider Demographics
NPI:1508158023
Name:OSTROVIAK, ELIZABETH A (LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:OSTROVIAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16524 JEALAM RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-5316
Mailing Address - Country:US
Mailing Address - Phone:218-821-0784
Mailing Address - Fax:
Practice Address - Street 1:7945 STONE CREEK DR STE 140
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4606
Practice Address - Country:US
Practice Address - Phone:952-974-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist