MEDICARE: DANA JO OXENDALE M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	2519	MN

General Provider Information

NPI Number	:	1952581266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA JO OXENDALE M.A.

Provider Business Mailing Address
First Line	:	1772 STIEGER LAKE LN STE 200
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-7723
Country	:	US
Telephone Number	:	651-442-7836
Fax Number	:

Provider Business Practice Location Address
First Line	:	1772 STIEGER LAKE LN STE 200
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-7723
Country	:	US
Telephone Number	:	651-442-7836
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	11/02/2022

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