Provider Demographics
NPI:1689376543
Name:ALI, ADMAN A
Entity Type:Individual
Prefix:
First Name:ADMAN
Middle Name:A
Last Name:ALI
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 1:121 HENNEPIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-1802
Mailing Address - Country:US
Mailing Address - Phone:612-412-3318
Mailing Address - Fax:612-288-1805
Practice Address - Street 1:121 HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-1802
Practice Address - Country:US
Practice Address - Phone:612-412-3318
Practice Address - Fax:612-288-1805
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician