Provider Demographics
NPI:1821354531
Name:OSTENDORF, ELIZABETH MARY (MED, BCBA)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARY
Last Name:OSTENDORF
Suffix:
Gender:F
Credentials:MED, BCBA
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Mailing Address - Street 1:590 W HIGHWAY 105 STE 105
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9125
Mailing Address - Country:US
Mailing Address - Phone:719-649-5037
Mailing Address - Fax:719-368-8399
Practice Address - Street 1:9960 FEDERAL DR STE 130
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3848
Practice Address - Country:US
Practice Address - Phone:719-466-4809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-13-14747103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26780089Medicaid