Provider Demographics
NPI:1295760189
Name:OSTBLOOM, NORMAN D (LISW)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:D
Last Name:OSTBLOOM
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-7042
Mailing Address - Country:US
Mailing Address - Phone:515-232-5811
Mailing Address - Fax:515-232-7491
Practice Address - Street 1:7272 WURZBACH ROAD
Practice Address - Street 2:SUITE 601
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4803
Practice Address - Country:US
Practice Address - Phone:210-615-3428
Practice Address - Fax:210-593-9863
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS59272Medicare UPIN