Provider Demographics
NPI:1609567510
Name:OSTERHOUDT, JENNIFER LEIGH-ANN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEIGH-ANN
Last Name:OSTERHOUDT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 JUMP RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NC
Mailing Address - Zip Code:27569-8147
Mailing Address - Country:US
Mailing Address - Phone:919-588-0160
Mailing Address - Fax:
Practice Address - Street 1:2900 KIDD RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1862
Practice Address - Country:US
Practice Address - Phone:919-714-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0177921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical