Provider Demographics
NPI:1497434252
Name:AHMED, IDIL AHMED
Entity Type:Individual
Prefix:
First Name:IDIL
Middle Name:AHMED
Last Name:AHMED
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 1:4489 MARSH DR NE APT 329
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2292
Mailing Address - Country:US
Mailing Address - Phone:612-363-9690
Mailing Address - Fax:
Practice Address - Street 1:4489 MARSH DR NE APT 329
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-2292
Practice Address - Country:US
Practice Address - Phone:612-363-9690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician