Provider Demographics
NPI:1568126001
Name:IKPE, UDUAKOBONG N (PHD, JD)
Entity Type:Individual
Prefix:
First Name:UDUAKOBONG
Middle Name:N
Last Name:IKPE
Suffix:
Gender:F
Credentials:PHD, JD
Other - Prefix:
Other - First Name:UDUAKOBONG
Other - Middle Name:
Other - Last Name:IKPE-WELCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, JD
Mailing Address - Street 1:5409 MARYLAND WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1084
Mailing Address - Country:US
Mailing Address - Phone:305-213-1087
Mailing Address - Fax:
Practice Address - Street 1:5409 MARYLAND WAY STE 202
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1084
Practice Address - Country:US
Practice Address - Phone:305-213-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2070103TC0700X
FL9728103TC0700X
LA1447103TC0700X
TN3330103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical