Provider Demographics
NPI:1619733581
Name:YAKUB, ABDIRIZAK
Entity Type:Individual
Prefix:
First Name:ABDIRIZAK
Middle Name:
Last Name:YAKUB
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 1:2613 GARFIELD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1336
Mailing Address - Country:US
Mailing Address - Phone:612-670-6164
Mailing Address - Fax:
Practice Address - Street 1:6260 HIGHWAY 65 NE STE 303
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5150
Practice Address - Country:US
Practice Address - Phone:614-218-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician