1821354531 NPI number — MS. ELIZABETH MARY OSTENDORF M.ED., BCBA

Table of content: MS. ELIZABETH MARY OSTENDORF M.ED., BCBA (NPI 1821354531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821354531 NPI number — MS. ELIZABETH MARY OSTENDORF M.ED., BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSTENDORF
Provider First Name:
ELIZABETH
Provider Middle Name:
MARY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821354531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
590 W HIGHWAY 105 STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONUMENT
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80132-9125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-649-5037
Provider Business Mailing Address Fax Number:
719-368-8399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9960 FEDERAL DR STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80921-3848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-466-4809
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-13-14747 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 26780089 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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