1255577037 NPI number — IMMACULATA CHIAGHALAM OSUEKE LLMSW

Table of content: IMMACULATA CHIAGHALAM OSUEKE LLMSW (NPI 1255577037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255577037 NPI number — IMMACULATA CHIAGHALAM OSUEKE LLMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSUEKE
Provider First Name:
IMMACULATA
Provider Middle Name:
CHIAGHALAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LLMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255577037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21860 STRATFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48237-2534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-968-3598
Provider Business Mailing Address Fax Number:
313-270-2955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15800 W MCNICHOLS RD
Provider Second Line Business Practice Location Address:
SUITE 223
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48235-3566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-270-2922
Provider Business Practice Location Address Fax Number:
313-270-2955
Provider Enumeration Date:
12/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  6802078152 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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