Healthcare Provider Details

I. General information

NPI: 1043122591
Provider Name (Legal Business Name): JENNIFER O'DELL LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BEAR FARM RD
NORTHFIELD VT
05663-4438
US

IV. Provider business mailing address

211 BEAR FARM RD
NORTHFIELD VT
05663-4438
US

V. Phone/Fax

Practice location:
  • Phone: 802-433-3950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0135898
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: