Provider Demographics
NPI:1942666342
Name:ODDO, MADISON MARLENE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:MARLENE
Last Name:ODDO
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3746 E AVENUE J8
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-5898
Mailing Address - Country:US
Mailing Address - Phone:661-733-5872
Mailing Address - Fax:
Practice Address - Street 1:2730 WILSHIRE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4724
Practice Address - Country:US
Practice Address - Phone:310-310-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-20934103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst