Provider Demographics
NPI:1679460117
Name:ISAHAQ, LUL ALI
Entity type:Individual
Prefix:
First Name:LUL
Middle Name:ALI
Last Name:ISAHAQ
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 1:1772 LAFOND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1715
Mailing Address - Country:US
Mailing Address - Phone:651-331-1171
Mailing Address - Fax:
Practice Address - Street 1:450 SYNDICATE ST N STE 198
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4127
Practice Address - Country:US
Practice Address - Phone:651-208-9604
Practice Address - Fax:612-460-6298
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician