Jacqueline S Odom PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

JACQUELINE S ODOM PHD

Practice address

30375 Northwestern Hwy Ste 200
Farmington Hills, MI 48334-3299

Phone

(248) 202-3367

Fax

(248) 254-3333

NPI assigned

May 17, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacqueline S Odom, PH.D.

Title

President

Phone

(248) 202-3367

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337212800000",
    "number": "1437419025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6250 GILBERT LAKE RD",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483011926",
            "telephone_number": "248-202-3367",
            "fax_number": "248-254-3333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30375 NORTHWESTERN HWY STE 200",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343299",
            "telephone_number": "248-202-3367",
            "fax_number": "248-254-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACQUELINE S ODOM PHD",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-17",
        "last_updated": "2012-05-17",
        "status": "A",
        "authorized_official_last_name": "ODOM",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-202-3367",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madisyn Jacobson
• Bethany Jacoby
• Kylie Jacoby
• Karleah Jacocks
• Erin Jacot
• Jacquelyn Chu D.D.S.,P.C.
• Brennah Jacques
• Isabel Jacques
• Olivia Jadala
• Brenna Jaeger-Marks

• Clinical Psychologist in Farmington Hills, MI
• Providers in Farmington Hills, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.