Provider Demographics
NPI:1275931511
Name:OLUWO, FUNKE DEBRA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:FUNKE
Middle Name:DEBRA
Last Name:OLUWO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:FUNKE
Other - Middle Name:DEBRA
Other - Last Name:OLUWO-SOTUMINU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8422 NORTHERN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-1914
Mailing Address - Country:US
Mailing Address - Phone:713-401-8405
Mailing Address - Fax:
Practice Address - Street 1:8422 NORTHERN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-1914
Practice Address - Country:US
Practice Address - Phone:713-401-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110562235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist