Provider Demographics
NPI:1700988854
Name:OEDEKOVEN, VIRGINIA KAY (LPC)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:KAY
Last Name:OEDEKOVEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:KAY
Other - Last Name:OEDEKOVEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:801 E 4TH ST
Mailing Address - Street 2:SUITE 14D
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4061
Mailing Address - Country:US
Mailing Address - Phone:307-686-9422
Mailing Address - Fax:307-685-4391
Practice Address - Street 1:801 E 4TH ST
Practice Address - Street 2:SUITE 14D
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4061
Practice Address - Country:US
Practice Address - Phone:307-686-9422
Practice Address - Fax:307-685-4391
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY314216OtherBLUE CROSS BLUE SHIELD