Active NPI
Jacqueline S Odom, PHD
- Clinical Psychologist
- Royal Oak, MI
National Provider Identifier
1881763464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- JO010213
- Practice address
- 4949 Coolidge Hwy
Royal Oak, MI 48073-1026 - Phone
- (248) 655-5900
- Fax
- (248) 655-5901
- NPI assigned
- Nov 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | JO010213 | MI | Primary |
Addresses
Primary practice location
4949 Coolidge Hwy
Royal Oak, MI 48073-1026
Mailing address
6250 Gilbert Lake Rd
Bloomfield Hills, MI 48301-1926
Phone (248) 645-1231
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| JO010213 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881763464",
"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": "248-645-1231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4949 COOLIDGE HWY",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480731026",
"telephone_number": "248-655-5900",
"fax_number": "248-655-5901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODOM",
"first_name": "JACQUELINE",
"middle_name": "S",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "JO010213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Royal Oak, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.