Healthcare Provider Details

I. General information

NPI: 1194288639
Provider Name (Legal Business Name): YABOME OLOSUNDE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 GLENDALE AVE
TOLEDO OH
43614-2914
US

IV. Provider business mailing address

1825 GLENDALE AVE
TOLEDO OH
43614-2914
US

V. Phone/Fax

Practice location:
  • Phone: 419-721-4432
  • Fax:
Mailing address:
  • Phone: 419-721-4432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS.2512824
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: