Provider Demographics
NPI:1093276305
Name:TIMBO, HABIE SADIKA
Entity Type:Individual
Prefix:
First Name:HABIE
Middle Name:SADIKA
Last Name:TIMBO
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 1:2711 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-1647
Mailing Address - Country:US
Mailing Address - Phone:563-388-1039
Mailing Address - Fax:563-388-1041
Practice Address - Street 1:2711 W 63RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-1647
Practice Address - Country:US
Practice Address - Phone:563-388-1039
Practice Address - Fax:563-388-1041
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health