Healthcare Provider Details

I. General information

NPI: 1528369410
Provider Name (Legal Business Name): SARAH SUSANNE ODELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 GYPSY LN
KENNETT SQ PA
19348-1466
US

IV. Provider business mailing address

502 W 7TH ST STE 100
ERIE PA
16502-1333
US

V. Phone/Fax

Practice location:
  • Phone: 206-641-4715
  • Fax:
Mailing address:
  • Phone: 253-442-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF001851
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF61274153
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: