Healthcare Provider Details

I. General information

NPI: 1972108033
Provider Name (Legal Business Name): JENNIFER OHRMUNDT MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16694 100TH ST
OAK PARK MN
56357-8536
US

IV. Provider business mailing address

16694 100TH ST
OAK PARK MN
56357-8536
US

V. Phone/Fax

Practice location:
  • Phone: 320-761-3019
  • Fax:
Mailing address:
  • Phone: 320-761-3019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27127
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: