Provider Demographics
NPI:1639354210
Name:JIMONU, ADAKU
Entity type:Individual
Prefix:
First Name:ADAKU
Middle Name:
Last Name:JIMONU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 169TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-2138
Mailing Address - Country:US
Mailing Address - Phone:708-798-9082
Mailing Address - Fax:
Practice Address - Street 1:2 OLYMPUS DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4827
Practice Address - Country:US
Practice Address - Phone:708-614-1782
Practice Address - Fax:708-429-5868
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILAN64161099P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist