MEDICARE: MEGAN JENNIFER OUDEKERK PSYD, LMFT, RPT-S

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	1852	MN

General Provider Information

NPI Number	:	1679786099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN JENNIFER OUDEKERK PSYD, LMFT, RPT-S

Provider Business Mailing Address
First Line	:	13816 FRANCHISE AVE
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-5613
Country	:	US
Telephone Number	:	763-229-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3460 WASHINGTON DR STE 110
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-4301
Country	:	US
Telephone Number	:	651-688-0488
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	06/07/2022

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