Provider Demographics
NPI:1083310726
Name:ALI, ALEENA N/A
Entity Type:Individual
Prefix:
First Name:ALEENA
Middle Name:N/A
Last Name:ALI
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 1:2705 ANNAPOLIS LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3605
Mailing Address - Country:US
Mailing Address - Phone:832-997-9409
Mailing Address - Fax:
Practice Address - Street 1:2705 ANNAPOLIS LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3605
Practice Address - Country:US
Practice Address - Phone:832-997-9409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician