Provider Demographics
NPI:1467184226
Name:HASSAN, ABDULQADIR AWIL
Entity Type:Individual
Prefix:
First Name:ABDULQADIR
Middle Name:AWIL
Last Name:HASSAN
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 1:706 ROBERT ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2948
Mailing Address - Country:US
Mailing Address - Phone:952-393-7939
Mailing Address - Fax:651-207-4763
Practice Address - Street 1:706 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2948
Practice Address - Country:US
Practice Address - Phone:952-393-7939
Practice Address - Fax:651-207-4733
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician