Provider Demographics
NPI:1164133112
Name:ADEN, MOHAMED ABDI
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ABDI
Last Name:ADEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 VALLEY VIEW RD APT 241
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-1968
Mailing Address - Country:US
Mailing Address - Phone:617-898-8040
Mailing Address - Fax:
Practice Address - Street 1:13700 VALLEY VIEW RD APT 241
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-1968
Practice Address - Country:US
Practice Address - Phone:617-898-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR038129236111103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst