Provider Demographics
NPI:1265718753
Name:OLDENKAMP, SUSAN D (LPC, NCC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:OLDENKAMP
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5365
Mailing Address - Country:US
Mailing Address - Phone:208-319-1002
Mailing Address - Fax:208-343-0000
Practice Address - Street 1:717 N 11TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5365
Practice Address - Country:US
Practice Address - Phone:208-319-1002
Practice Address - Fax:208-343-0000
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4823101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional