Provider Demographics
NPI:1710490313
Name:FALADE, EMMANUEL OLUWADEMILADE
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:OLUWADEMILADE
Last Name:FALADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 DONEGAL DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2390
Mailing Address - Country:US
Mailing Address - Phone:651-356-1180
Mailing Address - Fax:
Practice Address - Street 1:6043 HUDSON RD STE 399J
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1028
Practice Address - Country:US
Practice Address - Phone:651-356-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker