Provider Demographics
NPI:1699409326
Name:HASSAN, ABDINASIR MUHUDIN SR
Entity Type:Individual
Prefix:
First Name:ABDINASIR
Middle Name:MUHUDIN
Last Name:HASSAN
Suffix:SR
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 1:5515 S DISCH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-2630
Mailing Address - Country:US
Mailing Address - Phone:612-323-6877
Mailing Address - Fax:
Practice Address - Street 1:5515 S DISCH AVE APT 1
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-2630
Practice Address - Country:US
Practice Address - Phone:612-323-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-09
Last Update Date:2023-08-31
Deactivation Date:2023-05-16
Deactivation Code:
Reactivation Date:2023-08-31
Provider Licenses
StateLicense IDTaxonomies
WIH25001393206001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical