Healthcare Provider Details

I. General information

NPI: 1053242404
Provider Name (Legal Business Name): JESSICA O'DELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 LEIGHTON AVE STE B
ANNISTON AL
36207-3805
US

IV. Provider business mailing address

1525 LEIGHTON AVE STE B
ANNISTON AL
36207-3805
US

V. Phone/Fax

Practice location:
  • Phone: 256-343-4080
  • Fax:
Mailing address:
  • Phone: 256-343-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6761G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: