Provider Demographics
NPI:1326818899
Name:HASSANNUUR, SULEKA
Entity Type:Individual
Prefix:
First Name:SULEKA
Middle Name:
Last Name:HASSANNUUR
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 1:3733 FOX TAIL TRL NW
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1698
Mailing Address - Country:US
Mailing Address - Phone:507-350-2120
Mailing Address - Fax:
Practice Address - Street 1:3733 FOX TAIL TRL NW
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1698
Practice Address - Country:US
Practice Address - Phone:507-350-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health