Provider Demographics
NPI:1700677903
Name:ABDI, RIDWAN
Entity type:Individual
Prefix:
First Name:RIDWAN
Middle Name:
Last Name:ABDI
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 1:641 89TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2302
Mailing Address - Country:US
Mailing Address - Phone:612-464-4132
Mailing Address - Fax:612-465-1874
Practice Address - Street 1:641 89TH AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-2302
Practice Address - Country:US
Practice Address - Phone:612-464-4132
Practice Address - Fax:612-465-1874
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician