Provider Demographics
NPI:1710778543
Name:ALI, HANAD MOHAMED
Entity type:Individual
Prefix:
First Name:HANAD
Middle Name:MOHAMED
Last Name:ALI
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 1:1808 UNIVERSITY AVE NE APT 111
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4315
Mailing Address - Country:US
Mailing Address - Phone:651-299-2996
Mailing Address - Fax:
Practice Address - Street 1:2021 E HENNEPIN AVE STE LL20
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2738
Practice Address - Country:US
Practice Address - Phone:612-259-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician