Provider Demographics
NPI:1952581266
Name:OXENDALE, DANA JO (MA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:JO
Last Name:OXENDALE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:JO
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1772 STIEGER LAKE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-7723
Mailing Address - Country:US
Mailing Address - Phone:651-442-7836
Mailing Address - Fax:
Practice Address - Street 1:1772 STIEGER LAKE LN STE 200
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-7723
Practice Address - Country:US
Practice Address - Phone:651-442-7836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2519106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist