Provider Demographics
NPI:1619657673
Name:MOHAMUD, AISHA HARED
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:HARED
Last Name:MOHAMUD
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 1:5970 W 136TH LN
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2481
Mailing Address - Country:US
Mailing Address - Phone:952-393-2249
Mailing Address - Fax:
Practice Address - Street 1:5970 W 136TH LN
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2481
Practice Address - Country:US
Practice Address - Phone:952-393-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician