Provider Demographics
NPI:1407529662
Name:AMDI, ABDIRAHMAN
Entity Type:Individual
Prefix:
First Name:ABDIRAHMAN
Middle Name:
Last Name:AMDI
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 1:1501 COLLEGE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-6205
Mailing Address - Country:US
Mailing Address - Phone:612-501-0641
Mailing Address - Fax:
Practice Address - Street 1:1501 SOUTHCROSS DR W
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-6938
Practice Address - Country:US
Practice Address - Phone:952-456-1474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician