Provider Demographics
NPI:1598640195
Name:OLATUNBOSUN, FOLASHADE
Entity type:Individual
Prefix:
First Name:FOLASHADE
Middle Name:
Last Name:OLATUNBOSUN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 COOL SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8237
Mailing Address - Country:US
Mailing Address - Phone:630-414-5257
Mailing Address - Fax:
Practice Address - Street 1:1444 N FARNSWORTH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-1640
Practice Address - Country:US
Practice Address - Phone:331-213-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490296321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical