Provider Demographics
NPI:1558046086
Name:MUSSE, HODO IBRAHIM
Entity Type:Individual
Prefix:
First Name:HODO
Middle Name:IBRAHIM
Last Name:MUSSE
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 1:1044 DAKOTA DR
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1266
Mailing Address - Country:US
Mailing Address - Phone:651-214-8982
Mailing Address - Fax:651-528-8871
Practice Address - Street 1:1044 DAKOTA DR
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1266
Practice Address - Country:US
Practice Address - Phone:651-214-8982
Practice Address - Fax:651-528-8871
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician