Provider Demographics
NPI:1265591291
Name:OELTJEN, ALICIA LEAH (MSW LICSW)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:LEAH
Last Name:OELTJEN
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:LEAH
Other - Last Name:KLEVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:500 JOHN ST
Mailing Address - City:STARBUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56381
Mailing Address - Country:US
Mailing Address - Phone:320-239-2257
Mailing Address - Fax:320-239-1420
Practice Address - Street 1:500 JOHN ST
Practice Address - Street 2:MINNEWASKA AREA SCHOOLS DAY TREATMENT PROGRAM
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381
Practice Address - Country:US
Practice Address - Phone:320-239-2257
Practice Address - Fax:320-239-1420
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN145941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN598K4KLOtherBLUE CROSS BLUE SHIELD