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NPI Code Detail

MEDICARE: MISS ADEDAYO ANIKE ADEGBEMLE B.SC

MEDICARE: MISS ADEDAYO ANIKE ADEGBEMLE B.SC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1740596212
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ADEDAYO ANIKE ADEGBEMLE B.SC
Provider Business Mailing Address
First Line : 615 CASE PL
Second Line :
City : EVANSTON
State : IL
Zip : 60202-3533
Country : US
Telephone Number : 773-707-9613
Fax Number : 312-747-8974
Provider Business Practice Location Address
First Line : 4313 S ASHLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60609-3140
Country : US
Telephone Number : 312-747-3560
Fax Number : 312-747-8974
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2010
Last Update Date : 08/23/2010

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