Healthcare Provider Details

I. General information

NPI: 1164158465
Provider Name (Legal Business Name): OLUWATONI O OGUNDARE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E 19TH AVE UNIT 2512
DENVER CO
80203-1339
US

IV. Provider business mailing address

550 E 19TH AVE UNIT 2512
DENVER CO
80203-1339
US

V. Phone/Fax

Practice location:
  • Phone: 630-986-7669
  • Fax:
Mailing address:
  • Phone: 630-986-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: