Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Chantelle Suzanne Odisho

Individual provider Marriage & Family Therapist · NPI 1336612688

Chantelle Suzanne Odisho is a Marriage and Family Therapist in Modesto, California. Qualified in 2018, 8 years ago. Practices with Permanente Medical Group Inc, a 10,941-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
8
Licensed in
CA
In the registry since
2019
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Practice location Address checks out

4700 Enterprise Way
Modesto, CA 95356
Phone: (209) 550-6073
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Marriage & Family Therapist (primary) Taxonomy 106H00000X · Licence 128823 (CA)

Record details

NPI number1336612688
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJanuary 9, 2019
Last updated in NPPESJune 1, 2022
Certification dateJune 1, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMARRIAGE AND FAMILY THERAPIST
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Permanente Medical Group Inc — 10941 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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