Provider Demographics
NPI:1962140848
Name:EJIOGU, CHUKWUDEBELU FRANKLIN
Entity type:Individual
Prefix:
First Name:CHUKWUDEBELU
Middle Name:FRANKLIN
Last Name:EJIOGU
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 1:3019 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3342
Mailing Address - Country:US
Mailing Address - Phone:423-788-4232
Mailing Address - Fax:
Practice Address - Street 1:3019 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3342
Practice Address - Country:US
Practice Address - Phone:423-788-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-22
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty