Provider Demographics
NPI:1245115005
Name:OJEWANDE, BOLUWATIFE OLAOLUWA
Entity type:Individual
Prefix:
First Name:BOLUWATIFE
Middle Name:OLAOLUWA
Last Name:OJEWANDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ANTHONY DR APT D
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-6804
Mailing Address - Country:US
Mailing Address - Phone:314-793-7153
Mailing Address - Fax:
Practice Address - Street 1:210 ANTHONY DR APT D
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-6804
Practice Address - Country:US
Practice Address - Phone:314-793-7153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILNA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker