MEDICARE: YVETTE ODAH M.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1124455142	OTHER	WA	NPI

General Provider Information

NPI Number	:	1457756504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE ODAH M.ED.

Provider Business Mailing Address
First Line	:	8117 STONE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4414
Country	:	US
Telephone Number	:	206-851-6858
Fax Number	:

Provider Business Practice Location Address
First Line	:	8117 STONE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4414
Country	:	US
Telephone Number	:	206-535-8876
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2014
Last Update Date	:	10/31/2014

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