Provider Demographics
NPI:1326893520
Name:OSMAN, AWO AHMED
Entity Type:Individual
Prefix:
First Name:AWO
Middle Name:AHMED
Last Name:OSMAN
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 1:541 DEVINE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-2314
Mailing Address - Country:US
Mailing Address - Phone:612-817-6005
Mailing Address - Fax:
Practice Address - Street 1:3111 124TH AVE NW STE 150
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4581
Practice Address - Country:US
Practice Address - Phone:763-272-5877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician