Provider Demographics
NPI:1710409354
Name:AJIBADE, ADEBAYO (MED)
Entity Type:Individual
Prefix:
First Name:ADEBAYO
Middle Name:
Last Name:AJIBADE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:OLABAYO
Other - Middle Name:
Other - Last Name:AJIBADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4333 JARBOE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3526
Mailing Address - Country:US
Mailing Address - Phone:469-951-6376
Mailing Address - Fax:
Practice Address - Street 1:8629 BLUEJACKET ST STE 100
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1700
Practice Address - Country:US
Practice Address - Phone:913-677-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor