Healthcare Provider Details

I. General information

NPI: 1346849254
Provider Name (Legal Business Name): OLADOYIN OKUNOREN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 DUNLAP CT
SAVOY IL
61874-9501
US

IV. Provider business mailing address

7 DUNLAP CT
SAVOY IL
61874-9501
US

V. Phone/Fax

Practice location:
  • Phone: 217-352-0200
  • Fax: 217-607-1139
Mailing address:
  • Phone: 217-352-0200
  • Fax: 217-607-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.022678
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: