Provider Demographics
NPI:1699813576
Name:OSTEN, KEVIN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:OSTEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 408818
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-8818
Mailing Address - Country:US
Mailing Address - Phone:773-220-5452
Mailing Address - Fax:
Practice Address - Street 1:980 N MICHIGAN AVE
Practice Address - Street 2:SUITE #1083
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4501
Practice Address - Country:US
Practice Address - Phone:773-220-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007148103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical