Provider Demographics
NPI:1164286910
Name:AHMED, HIBO (LEVEL I)
Entity Type:Individual
Prefix:
First Name:HIBO
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:LEVEL I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12203 ABERDEEN ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5174
Mailing Address - Country:US
Mailing Address - Phone:612-707-5235
Mailing Address - Fax:
Practice Address - Street 1:12203 ABERDEEN ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5174
Practice Address - Country:US
Practice Address - Phone:612-707-5235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician