Provider Demographics
NPI:1073071767
Name:HUSSEIN, DEEQAIFRAH A
Entity Type:Individual
Prefix:
First Name:DEEQAIFRAH
Middle Name:A
Last Name:HUSSEIN
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 1:1712 129TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6264
Mailing Address - Country:US
Mailing Address - Phone:612-384-6156
Mailing Address - Fax:612-259-8361
Practice Address - Street 1:3055 OLD HIGHWAY 8 STE 101D
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-2500
Practice Address - Country:US
Practice Address - Phone:612-367-4153
Practice Address - Fax:612-259-8361
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician