MEDICARE: RICHARD J ODIAM LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	005056	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689722373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J ODIAM LCSW

Provider Business Mailing Address
First Line	:	5827 CHARLOTTE ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64110-3017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9233 WARD PKWY
Second Line	:	SUITE 125
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-3366
Country	:	US
Telephone Number	:	913-327-4686
Fax Number	:	816-333-1776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	12/22/2014

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