MEDICARE: SUSAN A ADEWALE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		TX

General Provider Information

NPI Number	:	1700741790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN A ADEWALE

Provider Business Mailing Address
First Line	:	698 BASILICA BAY DR APT 8305
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-4999
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	698 BASILICA BAY DR APT 8305
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-4999
Country	:	US
Telephone Number	:	832-562-0308
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2025
Last Update Date	:	12/22/2025

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Directions to “ SUSAN A ADEWALE ” Practice Location

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