Olusoji Samuel Ibukun

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

1960 Evergreen Terrace Dr W Apt 1
Carbondale, IL 62901-3933

Phone

(618) 527-7057

NPI assigned

Jul 3, 2025

Last updated

Jul 3, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751500800000",
    "number": "1730078650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 EVERGREEN TERRACE DR W APT 1",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013933",
            "telephone_number": "618-527-7057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 EVERGREEN TERRACE DR W APT 1",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013933",
            "telephone_number": "618-527-7057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBUKUN",
        "first_name": "OLUSOJI",
        "middle_name": "SAMUEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-07-03",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Social Worker in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.