Provider Demographics
NPI:1225234180
Name:ODOM, KATHRYN MORROW (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MORROW
Last Name:ODOM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 TWO GAIT LN
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6749
Mailing Address - Country:US
Mailing Address - Phone:864-408-8527
Mailing Address - Fax:
Practice Address - Street 1:407 TWO GAIT LN
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6749
Practice Address - Country:US
Practice Address - Phone:864-408-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3524235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist