Provider Demographics
NPI:1568607489
Name:OLADUNJOYE, TASHINA E (MWS)
Entity Type:Individual
Prefix:
First Name:TASHINA
Middle Name:E
Last Name:OLADUNJOYE
Suffix:
Gender:F
Credentials:MWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54862 LUAN DR
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-9562
Mailing Address - Country:US
Mailing Address - Phone:219-879-0676
Mailing Address - Fax:219-873-9868
Practice Address - Street 1:450 SAINT JOHN RD
Practice Address - Street 2:SUITE 525
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7354
Practice Address - Country:US
Practice Address - Phone:219-879-4621
Practice Address - Fax:219-873-2388
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100163580AMedicaid