Provider Demographics
NPI:1194378372
Name:ODELL, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:ODELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 E JOLLY RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6804
Mailing Address - Country:US
Mailing Address - Phone:517-393-5203
Mailing Address - Fax:517-393-8968
Practice Address - Street 1:621 E JOLLY RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-6804
Practice Address - Country:US
Practice Address - Phone:517-393-5203
Practice Address - Fax:517-393-8968
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician