Provider Demographics
NPI:1922768134
Name:OSMAN, KASSIM ABDI
Entity Type:Individual
Prefix:
First Name:KASSIM
Middle Name:ABDI
Last Name:OSMAN
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 1:4725 EXCELSIOR BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3047
Mailing Address - Country:US
Mailing Address - Phone:952-888-7055
Mailing Address - Fax:
Practice Address - Street 1:4236 PARK GLEN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4758
Practice Address - Country:US
Practice Address - Phone:952-888-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst