Provider Demographics
NPI:1992879829
Name:OLDENBURG, LEE SATEREN (MA)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:SATEREN
Last Name:OLDENBURG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 AVENUE D
Mailing Address - Street 2:BUILDING B, SUITE 2
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3042
Mailing Address - Country:US
Mailing Address - Phone:406-245-4446
Mailing Address - Fax:406-259-4211
Practice Address - Street 1:1629 AVENUE D
Practice Address - Street 2:BUILDING B, SUITE 2
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3042
Practice Address - Country:US
Practice Address - Phone:406-245-4446
Practice Address - Fax:406-259-4211
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT99101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0254800Medicaid