Provider Demographics
NPI:1548958978
Name:IKECHUWU, CHIOMA
Entity type:Individual
Prefix:
First Name:CHIOMA
Middle Name:
Last Name:IKECHUWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 NICOLS RD STE 104
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3337
Mailing Address - Country:US
Mailing Address - Phone:651-900-2210
Mailing Address - Fax:
Practice Address - Street 1:4220 W OLD SHAKOPEE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-2949
Practice Address - Country:US
Practice Address - Phone:651-900-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician