Provider Demographics
NPI:1366934333
Name:BABAWALE, ADETUNJI OLAWALE
Entity type:Individual
Prefix:
First Name:ADETUNJI
Middle Name:OLAWALE
Last Name:BABAWALE
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 1:245 SW LINCOLN ST APT 3319
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5048
Mailing Address - Country:US
Mailing Address - Phone:503-468-9218
Mailing Address - Fax:
Practice Address - Street 1:245 SW LINCOLN ST APT 3319
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5048
Practice Address - Country:US
Practice Address - Phone:503-468-9218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
ORA123061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator