Provider Demographics
NPI:1063978195
Name:OLATEJU, OLUWAFISAYO (CCC, SLP)
Entity type:Individual
Prefix:
First Name:OLUWAFISAYO
Middle Name:
Last Name:OLATEJU
Suffix:
Gender:F
Credentials:CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 RESEARCH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3289
Mailing Address - Country:US
Mailing Address - Phone:800-498-2071
Mailing Address - Fax:
Practice Address - Street 1:2200 RESEARCH BOULEVARD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77303
Practice Address - Country:US
Practice Address - Phone:832-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program