MEDICARE: JENNIFER OLIVER-KING LMFT

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	LMFT 1526	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	HP59862	OTHER	MN	HEALTH PARTNERS
3	906590L	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1861426942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER OLIVER-KING LMFT

Provider Business Mailing Address
First Line	:	7026 E FISH LAKE RD
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-2832
Country	:	US
Telephone Number	:	612-239-5055
Fax Number	:	763-424-8315

Provider Business Practice Location Address
First Line	:	7026 E FISH LAKE RD
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-2832
Country	:	US
Telephone Number	:	612-239-5055
Fax Number	:	763-424-8315

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	06/11/2022

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