Provider Demographics
NPI:1629698063
Name:OGBONNAYA, MARIANNE (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:
Last Name:OGBONNAYA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N KINZIE ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:IL
Mailing Address - Zip Code:60476-1116
Mailing Address - Country:US
Mailing Address - Phone:312-515-4550
Mailing Address - Fax:
Practice Address - Street 1:200 N KINZIE ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:IL
Practice Address - Zip Code:60476-1116
Practice Address - Country:US
Practice Address - Phone:312-515-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health