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NPI Code Detail

MEDICARE: JENNIFER ODLE SUDRC I

MEDICARE: JENNIFER ODLE SUDRC I
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
1101YA0400XAddiction (Substance Use Disorder) Counselor25738CA

General Provider Information

NPI Number : 1548195068
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ODLE SUDRC I
Provider Business Mailing Address
First Line : 4858 APPIAN WAY APT 1
Second Line :
City : EL SOBRANTE
State : CA
Zip : 94803-1856
Country : US
Telephone Number : 925-798-7250
Fax Number :
Provider Business Practice Location Address
First Line : 2931 PROSPECT ST
Second Line :
City : CONCORD
State : CA
Zip : 94518-1025
Country : US
Telephone Number : 925-676-4840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2026
Last Update Date : 06/16/2026

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Directions to “ JENNIFER ODLE SUDRC I” Practice Location

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