Provider Demographics
NPI:1861668972
Name:O'DELL, ALLISON D (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:D
Last Name:O'DELL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-0054
Mailing Address - Country:US
Mailing Address - Phone:417-359-8093
Mailing Address - Fax:417-359-8094
Practice Address - Street 1:2411 FAIRLAWN DRIVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836
Practice Address - Country:US
Practice Address - Phone:417-359-8093
Practice Address - Fax:417-359-8094
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040189181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496004011Medicaid