Provider Demographics
NPI:1780377291
Name:UDOUJ, ISAAC
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:UDOUJ
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:PO BOX 10267
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-0003
Mailing Address - Country:US
Mailing Address - Phone:501-358-3635
Mailing Address - Fax:501-358-6536
Practice Address - Street 1:1301 MUSEUM RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4739
Practice Address - Country:US
Practice Address - Phone:501-358-6535
Practice Address - Fax:501-358-6536
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21-185648106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician