Provider Demographics
NPI:1558796060
Name:OESTMANN, JOANNA (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:
Last Name:OESTMANN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:MOGAVERO
Other - Last Name:CLEKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD
Mailing Address - Street 1:96188 MARSH LAKES DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-6877
Mailing Address - Country:US
Mailing Address - Phone:941-224-1559
Mailing Address - Fax:904-432-8692
Practice Address - Street 1:96188 MARSH LAKES DR
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-6877
Practice Address - Country:US
Practice Address - Phone:941-224-1559
Practice Address - Fax:904-432-8692
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4173101YM0800X
SCLPC 893101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional