Provider Demographics
NPI:1578157475
Name:OOSTENDORP, JACOB MICHAEL
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:MICHAEL
Last Name:OOSTENDORP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 BRIDGE ST STE C
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2921
Mailing Address - Country:US
Mailing Address - Phone:509-254-5053
Mailing Address - Fax:
Practice Address - Street 1:303 BRIDGE ST STE C
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2921
Practice Address - Country:US
Practice Address - Phone:509-254-5053
Practice Address - Fax:509-769-3500
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor