Provider Demographics
NPI:1083396956
Name:OLDHAM, ELISABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 NAGEL DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1560
Mailing Address - Country:US
Mailing Address - Phone:254-715-5593
Mailing Address - Fax:
Practice Address - Street 1:1310 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4681
Practice Address - Country:US
Practice Address - Phone:701-530-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND60521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical