Provider Demographics
NPI:1770312266
Name:HAJIEDA, AISHA KHEROW
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:KHEROW
Last Name:HAJIEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 ALDEN POND LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1895
Mailing Address - Country:US
Mailing Address - Phone:206-218-6403
Mailing Address - Fax:
Practice Address - Street 1:2021 E HENNEPIN AVE STE 187
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2187
Practice Address - Country:US
Practice Address - Phone:763-321-5694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician