Provider Demographics
NPI:1528369410
Name:ODELL, SARAH SUSANNE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SUSANNE
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 1:4555 DELRIDGE WAY SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1379
Mailing Address - Country:US
Mailing Address - Phone:768-020-6937
Mailing Address - Fax:
Practice Address - Street 1:4555 DELRIDGE WAY SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-1379
Practice Address - Country:US
Practice Address - Phone:768-020-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner