Provider Demographics
NPI:1972104131
Name:JAMA, HODAN AHMED
Entity Type:Individual
Prefix:
First Name:HODAN
Middle Name:AHMED
Last Name:JAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HODAN
Other - Middle Name:AHMED
Other - Last Name:JAMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3055 OLD HIGHWAY 8 STE 101F
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2500
Mailing Address - Country:US
Mailing Address - Phone:612-259-7615
Mailing Address - Fax:612-259-7889
Practice Address - Street 1:3055 OLD HIGHWAY 8 STE 101F
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-2500
Practice Address - Country:US
Practice Address - Phone:612-259-7615
Practice Address - Fax:612-259-7889
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2023-09-14
Deactivation Date:2020-11-16
Deactivation Code:
Reactivation Date:2023-09-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst