Provider Demographics
NPI:1912900069
Name:OLLENDORFF, JANE N (RN, MSW)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:N
Last Name:OLLENDORFF
Suffix:
Gender:F
Credentials:RN, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8128 CORNELL CT
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-3639
Mailing Address - Country:US
Mailing Address - Phone:314-721-7057
Mailing Address - Fax:314-387-5592
Practice Address - Street 1:8128 CORNELL CT
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-3639
Practice Address - Country:US
Practice Address - Phone:314-721-7057
Practice Address - Fax:314-387-5592
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0013051041C0700X
MO041690163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered163W00000XNursing Service ProvidersRegistered Nurse