Provider Demographics
NPI:1629651948
Name:RAGE, ABDULLAHI
Entity Type:Individual
Prefix:
First Name:ABDULLAHI
Middle Name:
Last Name:RAGE
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 1:3055 OLD HIGHWAY 8 STE 160
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2595
Mailing Address - Country:US
Mailing Address - Phone:763-205-5424
Mailing Address - Fax:763-205-6183
Practice Address - Street 1:3055 OLD HIGHWAY 8 STE 160
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-2595
Practice Address - Country:US
Practice Address - Phone:763-205-5424
Practice Address - Fax:763-205-6183
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health