MEDICARE: OLUFUNMILOLA A OKANLA-FALADE LICSW

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	1041C0700X	Clinical Social Worker	20150	MN

General Provider Information

NPI Number	:	1841626132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUFUNMILOLA A OKANLA-FALADE LICSW

Provider Business Mailing Address
First Line	:	3300 OAKDALE AVE N
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-2900
Country	:	US
Telephone Number	:	763-581-5372
Fax Number	:	763-581-6401

Provider Business Practice Location Address
First Line	:	3300 OAKDALE AVE N
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422
Country	:	US
Telephone Number	:	763-581-5372
Fax Number	:	763-581-6401

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

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	02/06/2026

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