Provider Demographics
NPI:1669779443
Name:OSTANSKI, JACQUELINE (LPC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:OSTANSKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 W UNION HILLS DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3029
Mailing Address - Country:US
Mailing Address - Phone:623-876-1246
Mailing Address - Fax:623-933-5463
Practice Address - Street 1:8715 W UNION HILLS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3029
Practice Address - Country:US
Practice Address - Phone:623-876-1246
Practice Address - Fax:623-933-5463
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional