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General NPI Number Information
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NPI Number | 1548195068
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Entity Type | Individual
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Provider Name | JENNIFER ODLE SUDRC I
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Gender | Female
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Dates
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Enumeration Date | 06/16/2026
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Last Update Date | 06/16/2026
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Provider Practice Location Address
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Address Line | 2931 PROSPECT ST
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City | CONCORD
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State | CA
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Zip | 94518-1025
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Country | US
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Telephone | 925-676-4840
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Fax |
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Provider Business Mailing Address
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Address Line | 4858 APPIAN WAY APT 1
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City | EL SOBRANTE
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State | CA
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Zip | 94803-1856
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Country | US
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Telephone | 925-798-7250
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 25738
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License Number State | CA
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