Provider Demographics
NPI:1376655340
Name:OLDENBURG, JENNIFER COOK (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:COOK
Last Name:OLDENBURG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:MARY
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:113 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-9063
Mailing Address - Country:US
Mailing Address - Phone:724-832-9096
Mailing Address - Fax:724-832-2249
Practice Address - Street 1:225 HUMPHREY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4571
Practice Address - Country:US
Practice Address - Phone:724-832-9096
Practice Address - Fax:724-832-2249
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009312L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA927893OtherHIGHMARK BLUE CROSS