Provider Demographics
NPI:1548244809
Name:O'DELL, STEVEN KELLY (MSW LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:KELLY
Last Name:O'DELL
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:BO
Other - Middle Name:KELLY
Other - Last Name:O'DELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1732 SE ASH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1526
Mailing Address - Country:US
Mailing Address - Phone:503-249-7844
Mailing Address - Fax:
Practice Address - Street 1:1732 SE ASH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1526
Practice Address - Country:US
Practice Address - Phone:503-249-7844
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR111136Medicare ID - Type Unspecified