Provider Demographics
NPI:1609376821
Name:OSTERGAARD, JILLYN ALICE (CMHC)
Entity Type:Individual
Prefix:MRS
First Name:JILLYN
Middle Name:ALICE
Last Name:OSTERGAARD
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 N 200 W
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2032
Mailing Address - Country:US
Mailing Address - Phone:435-752-8880
Mailing Address - Fax:435-752-8884
Practice Address - Street 1:1525 N 200 W
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2032
Practice Address - Country:US
Practice Address - Phone:435-752-8880
Practice Address - Fax:435-752-8884
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT146626-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health