Healthcare Provider Details

I. General information

NPI: 1447087523
Provider Name (Legal Business Name): DOLAPO RAJI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4708 RIDGEWOOD LN
GRAND FORKS ND
58201-2829
US

IV. Provider business mailing address

4708 RIDGEWOOD LN
GRAND FORKS ND
58201-2829
US

V. Phone/Fax

Practice location:
  • Phone: 701-335-3184
  • Fax:
Mailing address:
  • Phone: 701-335-3184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: