Provider Demographics
NPI:1740596212
Name:ADEGBEMLE, ADEDAYO ANIKE (BSC)
Entity Type:Individual
Prefix:MISS
First Name:ADEDAYO
Middle Name:ANIKE
Last Name:ADEGBEMLE
Suffix:
Gender:F
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 CASE PL
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3533
Mailing Address - Country:US
Mailing Address - Phone:773-707-9613
Mailing Address - Fax:312-747-8974
Practice Address - Street 1:4313 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-3140
Practice Address - Country:US
Practice Address - Phone:312-747-3560
Practice Address - Fax:312-747-8974
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health