Provider Demographics
NPI:1134733991
Name:RAMADAN, KHADIJAH ALANA
Entity type:Individual
Prefix:MS
First Name:KHADIJAH
Middle Name:ALANA
Last Name:RAMADAN
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:PO BOX 2222
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-7222
Mailing Address - Country:US
Mailing Address - Phone:612-314-6883
Mailing Address - Fax:
Practice Address - Street 1:1011 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2531
Practice Address - Country:US
Practice Address - Phone:612-548-0348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional