Healthcare Provider Details

I. General information

NPI: 1154239531
Provider Name (Legal Business Name): ADESHOLA O ADENIJI LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 ETNA ST STE 62
SAINT PAUL MN
55106-5870
US

IV. Provider business mailing address

401 SIBLEY ST APT 720
SAINT PAUL MN
55101-1935
US

V. Phone/Fax

Practice location:
  • Phone: 651-280-2877
  • Fax: 651-280-2877
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34018
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: