Provider Demographics
NPI:1386474559
Name:ABDI, JAMAL M
Entity type:Individual
Prefix:
First Name:JAMAL
Middle Name:M
Last Name:ABDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAMAL
Other - Middle Name:M
Other - Last Name:ABDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4224 W 141ST ST # 4224
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2051
Mailing Address - Country:US
Mailing Address - Phone:612-806-7460
Mailing Address - Fax:
Practice Address - Street 1:1800 ASPEN DR APT 105
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9200
Practice Address - Country:US
Practice Address - Phone:612-906-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-03
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1386474559101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1386474559Medicaid