Provider Demographics
NPI:1487852745
Name:OLDENBURG, JENNIFER SR (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:OLDENBURG
Suffix:SR
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:BETTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:15 1ST AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LONG PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56347
Mailing Address - Country:US
Mailing Address - Phone:320-732-3344
Mailing Address - Fax:320-732-3352
Practice Address - Street 1:15 1ST AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347
Practice Address - Country:US
Practice Address - Phone:320-732-3344
Practice Address - Fax:320-732-3352
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1699106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist