Provider Demographics
NPI:1659122901
Name:ALADE, KHADIJAT ABIMBOLA (MSW)
Entity Type:Individual
Prefix:
First Name:KHADIJAT
Middle Name:ABIMBOLA
Last Name:ALADE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8346 CODESA WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-5065
Mailing Address - Country:US
Mailing Address - Phone:754-276-7308
Mailing Address - Fax:
Practice Address - Street 1:2626 E 46TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2380
Practice Address - Country:US
Practice Address - Phone:463-213-3952
Practice Address - Fax:317-510-6577
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN9912362381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical