MEDICARE: KELVIN CHIAGOZIE OBODOAKU

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1366381865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELVIN CHIAGOZIE OBODOAKU

Provider Business Mailing Address
First Line	:	841 W SUNNYSIDE AVE APT 103
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-7291
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 E TOUHY AVE
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-3303
Country	:	US
Telephone Number	:	630-590-5571
Fax Number	:

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

Provider Enumeration Date	:	03/27/2026
Last Update Date	:	03/27/2026

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Directions to “ KELVIN CHIAGOZIE OBODOAKU ” Practice Location

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