Individual
KENNETH ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
3239 INDEPENDENCE RD, CANON CITY, CO 81212-9380
(719) 275-7650
Mailing address
1233 INDIANA AVE, CANON CITY, CO 81212-8659
(719) 315-2254
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/29/2014
Last updated
08/26/2016
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