Provider Demographics
NPI:1912203951
Name:ODDO, JARRETT (MA)
Entity Type:Individual
Prefix:MR
First Name:JARRETT
Middle Name:
Last Name:ODDO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 REPRESENTATIVE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-1240
Mailing Address - Country:US
Mailing Address - Phone:916-875-8017
Mailing Address - Fax:
Practice Address - Street 1:6705 REPRESENTATIVE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-1240
Practice Address - Country:US
Practice Address - Phone:916-875-8017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF58894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health