Provider Demographics
NPI:1922762582
Name:AHMED, IFRAH MOHAMMUD
Entity Type:Individual
Prefix:
First Name:IFRAH
Middle Name:MOHAMMUD
Last Name:AHMED
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 1:11070 CEDAR HILLS BLVD APT 328
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-3019
Mailing Address - Country:US
Mailing Address - Phone:816-888-9638
Mailing Address - Fax:
Practice Address - Street 1:11070 CEDAR HILLS BLVD APT 328
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-3019
Practice Address - Country:US
Practice Address - Phone:816-888-9638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician