Provider Demographics
NPI:1326793464
Name:YESUF, ZYIDA I (LICSW)
Entity Type:Individual
Prefix:
First Name:ZYIDA
Middle Name:I
Last Name:YESUF
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ZYIDA
Other - Middle Name:ISSA
Other - Last Name:YESUF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:2120 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2120 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3378
Practice Address - Country:US
Practice Address - Phone:651-774-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2024-02-05
Deactivation Date:2022-03-28
Deactivation Code:
Reactivation Date:2024-02-05
Provider Licenses
StateLicense IDTaxonomies
MN248511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical