Provider Information for 1013649458
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JESSICA OLADUMIYE LCSW
Sex: Female
NPI: 1013649458
Last Updated: 2022-09-25
Certification Date: 2022-09-25
Certification Date: 2022-09-25
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1013649458 | ||||||||||||||
| Enumeration Date | 2022-06-24 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 4300 N UNIVERSITY DR # A153 LAUDERHILL, FL 33351-6249 United States Phone: 816-204-7632 | Fax: | ||||||||||||||
| Primary Practice Address | 6650 LANDINGS DR APT 108 LAUDERHILL, FL 33319-5044 United States Phone: 816-204-7632 | Fax: | ||||||||||||||
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