1700988854 NPI number — MS. VIRGINIA KAY OEDEKOVEN LPC

Table of content: MS. VIRGINIA KAY OEDEKOVEN LPC (NPI 1700988854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700988854 NPI number — MS. VIRGINIA KAY OEDEKOVEN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OEDEKOVEN
Provider First Name:
VIRGINIA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OEDEKOVEN
Provider Other First Name:
GINNY
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1700988854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 E 4TH ST
Provider Second Line Business Mailing Address:
SUITE 14D
Provider Business Mailing Address City Name:
GILLETTE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82716-4061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-686-9422
Provider Business Mailing Address Fax Number:
307-685-4391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 E 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 14D
Provider Business Practice Location Address City Name:
GILLETTE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82716-4061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-686-9422
Provider Business Practice Location Address Fax Number:
307-685-4391
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  540 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 314216 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




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