Provider Demographics
NPI:1922700657
Name:ALI,, NIMO (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:NIMO
Middle Name:
Last Name:ALI,
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7635 148TH ST W STE 236
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7800
Mailing Address - Country:US
Mailing Address - Phone:612-405-2154
Mailing Address - Fax:
Practice Address - Street 1:7635 148TH ST W STE 236
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7800
Practice Address - Country:US
Practice Address - Phone:612-405-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN289051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical