Healthcare Provider Details

I. General information

NPI: 1417623455
Provider Name (Legal Business Name): OLUWASEUN OLOJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8815 COLUMBIA 100 PKWY STE 4
COLUMBIA MD
21045-2361
US

IV. Provider business mailing address

11622 SEQUOIA LN
BELTSVILLE MD
20705-1468
US

V. Phone/Fax

Practice location:
  • Phone: 877-776-8502
  • Fax:
Mailing address:
  • Phone: 240-938-4319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number02208L
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: