Provider Demographics
NPI:1750158515
Name:OWODUNNI, BOLUWATIFE IDOWU
Entity type:Individual
Prefix:
First Name:BOLUWATIFE
Middle Name:IDOWU
Last Name:OWODUNNI
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 1:1912 JESSE OWENS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-2909
Mailing Address - Country:US
Mailing Address - Phone:814-790-1978
Mailing Address - Fax:
Practice Address - Street 1:4111 ALDERWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6765
Practice Address - Country:US
Practice Address - Phone:425-977-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor