Provider Demographics
NPI:1679337455
Name:ABDIHOOSH, ADAN AHMED
Entity type:Individual
Prefix:
First Name:ADAN
Middle Name:AHMED
Last Name:ABDIHOOSH
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 1:1114 112TH LN NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4547
Mailing Address - Country:US
Mailing Address - Phone:612-644-8021
Mailing Address - Fax:
Practice Address - Street 1:1114 112TH LN NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4547
Practice Address - Country:US
Practice Address - Phone:612-644-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician