MEDICARE: YABOME OLOSUNDE LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	S.2512824

General Provider Information

NPI Number	:	1194288639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YABOME OLOSUNDE LSW

Provider Business Mailing Address
First Line	:	1825 GLENDALE AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2914
Country	:	US
Telephone Number	:	419-721-4432
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 GLENDALE AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2914
Country	:	US
Telephone Number	:	419-721-4432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	12/09/2025

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