Provider Demographics
NPI:1750528741
Name:JEGEDE, ADEJOKE B (PHD)
Entity type:Individual
Prefix:DR
First Name:ADEJOKE
Middle Name:B
Last Name:JEGEDE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2311 MUSTANG DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-1009
Mailing Address - Country:US
Mailing Address - Phone:817-600-8892
Mailing Address - Fax:682-503-6106
Practice Address - Street 1:6936 SEA HARBOR DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-7280
Practice Address - Country:US
Practice Address - Phone:817-600-8892
Practice Address - Fax:682-503-6106
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
NY017470103TC0700X
TX34277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist