Provider Demographics
NPI:1043661739
Name:OSLICA, AUSTIN (PLMSW)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:OSLICA
Suffix:
Gender:M
Credentials:PLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 CLUB HOUSE PKWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-8703
Mailing Address - Country:US
Mailing Address - Phone:479-225-6416
Mailing Address - Fax:501-224-1340
Practice Address - Street 1:2003 SE WALTON BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3725
Practice Address - Country:US
Practice Address - Phone:479-725-6000
Practice Address - Fax:479-750-4843
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8087C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical