Provider Demographics
NPI:1417334756
Name:OMOJOLA, JUMOKE
Entity Type:Individual
Prefix:
First Name:JUMOKE
Middle Name:
Last Name:OMOJOLA
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 1:4318 N 136TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5091
Mailing Address - Country:US
Mailing Address - Phone:402-981-6624
Mailing Address - Fax:
Practice Address - Street 1:4318 N 136TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5091
Practice Address - Country:US
Practice Address - Phone:402-981-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15811041C0700X
NE13741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical