Provider Demographics
NPI:1679786099
Name:OUDEKERK, MEGAN JENNIFER (PSYD, LMFT, RPT-S)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JENNIFER
Last Name:OUDEKERK
Suffix:
Gender:F
Credentials:PSYD, LMFT, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13816 FRANCHISE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5613
Mailing Address - Country:US
Mailing Address - Phone:763-229-3100
Mailing Address - Fax:
Practice Address - Street 1:3460 WASHINGTON DR STE 110
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4301
Practice Address - Country:US
Practice Address - Phone:651-688-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1852106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist