Provider Demographics
NPI:1225316979
Name:ODEN, CHERYL (MA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:ODEN
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 1:1112 VEACHS CT
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-3002
Mailing Address - Country:US
Mailing Address - Phone:765-472-2323
Mailing Address - Fax:
Practice Address - Street 1:1810 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-5737
Practice Address - Country:US
Practice Address - Phone:765-553-5691
Practice Address - Fax:765-553-5772
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002405A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health