Provider Demographics
NPI:1710728456
Name:ABDILLAHI, MOHAMED ADEN
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ADEN
Last Name:ABDILLAHI
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 1:105 BLAKE RD N APT 203
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8266
Mailing Address - Country:US
Mailing Address - Phone:651-278-4943
Mailing Address - Fax:
Practice Address - Street 1:105 BLAKE RD N APT 203
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8266
Practice Address - Country:US
Practice Address - Phone:651-278-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNOOOOOOOOOOOOOO104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker