Provider Demographics
NPI:1689561730
Name:MOALLIM, ZADIQ OMAR
Entity type:Individual
Prefix:
First Name:ZADIQ
Middle Name:OMAR
Last Name:MOALLIM
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 1:941 HILLWIND RD NE STE 301
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5965
Mailing Address - Country:US
Mailing Address - Phone:952-303-5803
Mailing Address - Fax:
Practice Address - Street 1:941 HILLWIND RD NE STE 301
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5965
Practice Address - Country:US
Practice Address - Phone:952-303-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician