Provider Demographics
NPI:1134698624
Name:ADETUNJI, OLUWATOYIN
Entity Type:Individual
Prefix:
First Name:OLUWATOYIN
Middle Name:
Last Name:ADETUNJI
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 1:8421 WAYZATA BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1394
Mailing Address - Country:US
Mailing Address - Phone:763-205-5424
Mailing Address - Fax:
Practice Address - Street 1:74 10TH AVE S
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1055
Practice Address - Country:US
Practice Address - Phone:320-774-1890
Practice Address - Fax:320-774-2299
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24254104100000X
MN01610101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker