Provider Demographics
NPI:1942637632
Name:ALI, JIHAN A (LICSW)
Entity Type:Individual
Prefix:
First Name:JIHAN
Middle Name:A
Last Name:ALI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 977
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-0977
Mailing Address - Country:US
Mailing Address - Phone:507-446-0431
Mailing Address - Fax:507-446-8014
Practice Address - Street 1:631 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2323
Practice Address - Country:US
Practice Address - Phone:507-446-0431
Practice Address - Fax:507-446-8014
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN210471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical