Provider Demographics
NPI:1073248050
Name:ODDEN, SUSAN M (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:ODDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:OLBRYCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:390 RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2226
Mailing Address - Country:US
Mailing Address - Phone:802-886-4500
Mailing Address - Fax:802-886-4560
Practice Address - Street 1:132 SO. MAIN STREET SUITE 100
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-7234
Practice Address - Country:US
Practice Address - Phone:802-295-3031
Practice Address - Fax:802-281-7080
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0135338101YP2500X
NH071623-21163W00000X
VT026.0113090163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional