Provider Demographics
NPI:1962213215
Name:AZANEBOAH, RICHARD ACKAH
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ACKAH
Last Name:AZANEBOAH
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 1:6425 S LOWE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-2790
Mailing Address - Country:US
Mailing Address - Phone:773-720-4124
Mailing Address - Fax:
Practice Address - Street 1:6425 S LOWE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-2790
Practice Address - Country:US
Practice Address - Phone:773-720-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician