Provider Demographics
NPI:1295384733
Name:ADENEKAN, ADEDAYO M (BEHAVIOR SPECIALIST)
Entity Type:Individual
Prefix:
First Name:ADEDAYO
Middle Name:M
Last Name:ADENEKAN
Suffix:
Gender:M
Credentials:BEHAVIOR SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 COUNTRY CLUB EST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-3631
Mailing Address - Country:US
Mailing Address - Phone:314-740-5639
Mailing Address - Fax:618-662-9519
Practice Address - Street 1:109 COUNTRY CLUB EST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-3631
Practice Address - Country:US
Practice Address - Phone:314-740-5639
Practice Address - Fax:618-662-9519
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty