Provider Demographics
NPI:1336647106
Name:KOLSTAD, JENNIFER OLINE (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:OLINE
Last Name:KOLSTAD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WARREN ST
Mailing Address - Street 2:STE 324
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3762
Mailing Address - Country:US
Mailing Address - Phone:507-246-2667
Mailing Address - Fax:507-514-0999
Practice Address - Street 1:100 WARREN ST
Practice Address - Street 2:STE 324
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3762
Practice Address - Country:US
Practice Address - Phone:507-246-2667
Practice Address - Fax:507-519-0444
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN196931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical