Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 2699 | SC |
Y | 101YP2500X | Professional Counselor | 6401011073 | MI |
NPI | 1003061425 |
---|---|
Provider Name | Mr. John Ostrowski JR. |
First Address | Ada, MI 49301-9413 |
Second Address | Ada, MI 49301-9413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2008 |
Last Update Date | 29/04/2010 |