Provider Demographics
NPI:1063868628
Name:MUDOH, API NGONUH (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:API
Middle Name:NGONUH
Last Name:MUDOH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 N HIGHLAND AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1460
Mailing Address - Country:US
Mailing Address - Phone:630-394-1379
Mailing Address - Fax:331-239-2705
Practice Address - Street 1:1315 N HIGHLAND AVE STE 202
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1460
Practice Address - Country:US
Practice Address - Phone:630-394-1379
Practice Address - Fax:331-239-2705
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL149.0261751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program