Provider Demographics
NPI:1033842794
Name:ABDI, KEDRA AHNEDRABI
Entity Type:Individual
Prefix:
First Name:KEDRA
Middle Name:AHNEDRABI
Last Name:ABDI
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 1:36 WILLIAMS AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3462
Mailing Address - Country:US
Mailing Address - Phone:651-395-8491
Mailing Address - Fax:
Practice Address - Street 1:36 WILLIAMS AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3462
Practice Address - Country:US
Practice Address - Phone:651-395-8491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty