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General NPI Number Information
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NPI Number | 1861046989
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Entity Type | Individual
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Provider Name | SOPHIA ODEH
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Gender | Female
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Dates
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Enumeration Date | 07/26/2019
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 444 N MICHIGAN AVE FL 30
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City | CHICAGO
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State | IL
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Zip | 60611-3964
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Country | US
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Telephone | 847-733-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 444 N MICHIGAN AVE FL 30
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City | CHICAGO
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State | IL
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Zip | 60611-3964
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Country | US
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Telephone | 847-733-4300
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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