Provider Demographics
NPI:1982869541
Name:ODELL, TAMMY JOLENE (AUD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:JOLENE
Last Name:ODELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 N UNION BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4900
Mailing Address - Country:US
Mailing Address - Phone:719-574-6653
Mailing Address - Fax:719-574-2778
Practice Address - Street 1:3920 N UNION BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4900
Practice Address - Country:US
Practice Address - Phone:719-574-6653
Practice Address - Fax:719-574-2778
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO266231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist