Healthcare Provider Details

I. General information

NPI: 1215010541
Provider Name (Legal Business Name): BRENDA DAWN O'DELL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA DAWN HIGDON

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21210 NW MAUZEY RD
HILLSBORO OR
97124
US

IV. Provider business mailing address

PO BOX 82819
PORTLAND OR
97282-0819
US

V. Phone/Fax

Practice location:
  • Phone: 503-439-9531
  • Fax: 503-431-3841
Mailing address:
  • Phone: 503-233-5405
  • Fax: 503-233-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: