Provider Demographics
NPI:1235646605
Name:ODUM, JESSICA (M ED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ODUM
Suffix:
Gender:F
Credentials:M ED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 WATERMARK WAY
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3101
Mailing Address - Country:US
Mailing Address - Phone:708-305-4288
Mailing Address - Fax:
Practice Address - Street 1:538 MORRIS DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-1032
Practice Address - Country:US
Practice Address - Phone:815-353-1884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-06
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-17-28992103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst