Provider Demographics
NPI:1386221133
Name:ODUYALE, ADEOLA MARY
Entity Type:Individual
Prefix:
First Name:ADEOLA
Middle Name:MARY
Last Name:ODUYALE
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 1:1827 NE 44TH AVE STE 390
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1461
Mailing Address - Country:US
Mailing Address - Phone:503-963-6494
Mailing Address - Fax:503-963-6496
Practice Address - Street 1:1827 NE 44TH AVE STE 390
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1461
Practice Address - Country:US
Practice Address - Phone:503-963-6494
Practice Address - Fax:503-963-6496
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst