Provider Demographics
NPI:1558705731
Name:OSTREM, AMY KATHLEEN (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHLEEN
Last Name:OSTREM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4721
Mailing Address - Country:US
Mailing Address - Phone:715-675-3458
Mailing Address - Fax:715-675-7238
Practice Address - Street 1:741 N 1ST ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4721
Practice Address - Country:US
Practice Address - Phone:715-675-3458
Practice Address - Fax:715-675-7238
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1735-226101YM0800X
WI5635-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health