Provider Demographics
NPI:1972270700
Name:ODEGARD, ZOE DEHN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:DEHN
Last Name:ODEGARD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 SELBY AVE APT 459
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6794
Mailing Address - Country:US
Mailing Address - Phone:651-757-7248
Mailing Address - Fax:
Practice Address - Street 1:333 GRAND AVE STE 205
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2583
Practice Address - Country:US
Practice Address - Phone:651-294-2307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-28
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty