Provider Demographics
NPI:1679286967
Name:AHMED, MANAL YUSSUF
Entity Type:Individual
Prefix:
First Name:MANAL
Middle Name:YUSSUF
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 1:333 RICE CREEK TER NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4437
Mailing Address - Country:US
Mailing Address - Phone:763-843-0755
Mailing Address - Fax:
Practice Address - Street 1:3055 OLD HIGHWAY 8 STE 190
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:612-267-6293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health