Individual
GINA L OSTERLOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA, CADC
Contact information
Practice address
540 S 16TH ST, PAYETTE, ID 83661-3513
(208) 297-8889
(208) 485-9475
Mailing address
540 S 16TH ST STE 118, PAYETTE, ID 83661-3514
(208) 297-8889
(208) 485-9475
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11675
ID
Other
Enumeration date
08/05/2019
Last updated
08/05/2019
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