Provider Demographics
NPI:1578370102
Name:ADETUNJI, OPEYEMI A (LSW)
Entity type:Individual
Prefix:
First Name:OPEYEMI
Middle Name:A
Last Name:ADETUNJI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W FARWELL AVE APT 504
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4927
Mailing Address - Country:US
Mailing Address - Phone:847-890-3262
Mailing Address - Fax:
Practice Address - Street 1:11848 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4734
Practice Address - Country:US
Practice Address - Phone:773-431-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.106896104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty