Active NPI
Jenny Odden, LPCC
- Professional Counselor
- Saint Anthony, MN
National Provider Identifier
1366913469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- CC02002
- Practice address
- 3803 Silver Lake Rd NE Ste 100
Saint Anthony, MN 55421-4575 - Phone
- (612) 712-1993
- NPI assigned
- Dec 16, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | CC02002 | MN | Primary |
Addresses
Primary practice location
3803 Silver Lake Rd NE Ste 100
Saint Anthony, MN 55421-4575
Mailing address
3803 Silver Lake Rd NE Ste 100
Saint Anthony, MN 55421-4575
Phone (612) 712-1993
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241126004233 | MN | Practitioner - Mental Health Counselor | 9830624949 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CC02002 | MN | MD | Professional Counselor |
| 2002 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705536000000",
"number": "1366913469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3803 SILVER LAKE RD NE STE 100",
"city": "SAINT ANTHONY",
"state": "MN",
"postal_code": "554214575",
"telephone_number": "612-712-1993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3803 SILVER LAKE RD NE STE 100",
"city": "SAINT ANTHONY",
"state": "MN",
"postal_code": "554214575",
"telephone_number": "612-712-1993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODDEN",
"first_name": "JENNY",
"credential": "LPCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-12-16",
"last_updated": "2024-01-18",
"certification_date": "2024-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "CC02002",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Anthony, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.