Provider Demographics
NPI:1942399977
Name:OOSTERHOUS, BEVERLY S (MSE)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:S
Last Name:OOSTERHOUS
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 C MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1128
Mailing Address - Country:US
Mailing Address - Phone:920-722-8150
Mailing Address - Fax:920-722-0142
Practice Address - Street 1:1244 C MIDWAY RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1128
Practice Address - Country:US
Practice Address - Phone:920-722-8150
Practice Address - Fax:920-722-0142
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2562125101YM0800X
WI894121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39787700Medicaid