Provider Demographics
NPI:1134804743
Name:YUSSUF, HIBAAQ
Entity type:Individual
Prefix:
First Name:HIBAAQ
Middle Name:
Last Name:YUSSUF
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 1:14274 IRVING AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-7111
Mailing Address - Country:US
Mailing Address - Phone:952-388-3681
Mailing Address - Fax:
Practice Address - Street 1:1701 AMERICAN BLVD E STE 16
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1401
Practice Address - Country:US
Practice Address - Phone:952-454-0421
Practice Address - Fax:952-426-4935
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician