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Individual

AGNES CECILIA OSTERHOLT-POLSTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MSW,LCSWS

Contact information

Practice address
4235 FLAGSTAFF COVE, FORT WAYNE, IN 46815
(260) 969-6600
(260) 969-6601
Mailing address
4235 FLAGSTAFF COVE, FORT WAYNE, IN 46815
(260) 969-6600
(260) 969-6601

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34002679A
IN

Other

Enumeration date
07/30/2006
Last updated
07/31/2014
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