Provider Demographics
NPI:1427091107
Name:ODELL, ROBERT GLEN (LICSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GLEN
Last Name:ODELL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 10TH AVE E APT 2
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4158
Mailing Address - Country:US
Mailing Address - Phone:206-282-3137
Mailing Address - Fax:
Practice Address - Street 1:2366 EASTLAKE AVE E.
Practice Address - Street 2:#221
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3366
Practice Address - Country:US
Practice Address - Phone:206-282-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW50451041C0700X
WALW000050451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical