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General NPI Number Information
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NPI Number | 1427091107
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Entity Type | Individual
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Provider Name | ROBERT GLEN ODELL LICSW
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 2366 EASTLAKE AVE E. #221
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City | SEATTLE
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State | WA
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Zip | 98102-3366
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Country | US
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Telephone | 206-282-3137
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Fax |
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Provider Business Mailing Address
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Address Line | 2226 10TH AVE E APT 2
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City | SEATTLE
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State | WA
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Zip | 98102-4158
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Country | US
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Telephone | 206-282-3137
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW5045
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW00005045
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License Number State | WA
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