Provider Demographics
NPI:1245908847
Name:EKERE, CHUKUSOM BENSON
Entity type:Individual
Prefix:MR
First Name:CHUKUSOM
Middle Name:BENSON
Last Name:EKERE
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 1:15933 CANADA GOOSE LOOP
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-5562
Mailing Address - Country:US
Mailing Address - Phone:571-572-8488
Mailing Address - Fax:
Practice Address - Street 1:15933 CANADA GOOSE LOOP
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-5562
Practice Address - Country:US
Practice Address - Phone:571-572-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist