MEDICARE: MRS. NIKKI L. O'DELL MSW, 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	101YM0800X	Mental Health Counselor		MO

General Provider Information

NPI Number	:	1790799112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NIKKI L. O'DELL MSW, LCSW

Provider Business Mailing Address
First Line	:	3100 NE 83RD ST
Second Line	:	SUITE 2500
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-4400
Country	:	US
Telephone Number	:	816-468-6336
Fax Number	:	816-468-0289

Provider Business Practice Location Address
First Line	:	3100 NE 83RD ST
Second Line	:	SUITE 2500
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-4400
Country	:	US
Telephone Number	:	816-468-6336
Fax Number	:	816-468-0289

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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