Provider Demographics
NPI:1710455043
Name:HAJI, ABSHIR YUSUF
Entity Type:Individual
Prefix:
First Name:ABSHIR
Middle Name:YUSUF
Last Name:HAJI
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 1:201 LYNDALE AVE S STE I
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5758
Mailing Address - Country:US
Mailing Address - Phone:614-822-7532
Mailing Address - Fax:
Practice Address - Street 1:306 7TH ST NW APT 12
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-4272
Practice Address - Country:US
Practice Address - Phone:614-822-7532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician