Provider Demographics
NPI:1447507397
Name:ONILENLA, DAMILOLA N (MS)
Entity type:Individual
Prefix:
First Name:DAMILOLA
Middle Name:N
Last Name:ONILENLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 LINWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-3571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 LIVINGSTON ST
Practice Address - Street 2:SUITE 1101
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5078
Practice Address - Country:US
Practice Address - Phone:718-625-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022949235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist