Provider Demographics
NPI:1740093269
Name:UTETIWABO, CHANCE MUYOBOKE
Entity type:Individual
Prefix:
First Name:CHANCE
Middle Name:MUYOBOKE
Last Name:UTETIWABO
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 1:441 VOYAGER DR
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-9152
Mailing Address - Country:US
Mailing Address - Phone:518-423-0598
Mailing Address - Fax:
Practice Address - Street 1:441 VOYAGER DR
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-9152
Practice Address - Country:US
Practice Address - Phone:518-423-0598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities