Healthcare Provider Details

I. General information

NPI: 1588459127
Provider Name (Legal Business Name): ADERI OKUMU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9065 LYNDALE AVE S
BLOOMINGTON MN
55420-3502
US

IV. Provider business mailing address

9065 LYNDALE AVE S
BLOOMINGTON MN
55420-3502
US

V. Phone/Fax

Practice location:
  • Phone: 952-452-6116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: