Individual
JACQUELINE MAE ODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6110 SHALLOWFORD RD, CHATTANOOGA, TN 37421
(800) 632-6074
(866) 341-7509
Mailing address
PO BOX 10414, LARGO, FL 33773
(800) 632-6074
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LSW0000003919
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3926147
—
TN
Enumeration date
09/19/2006
Last updated
07/09/2007
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