Provider Demographics
NPI:1265264709
Name:HASSAN, KADRO MOHAMUD
Entity type:Individual
Prefix:
First Name:KADRO
Middle Name:MOHAMUD
Last Name:HASSAN
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 1:7570 147TH ST W STE 120
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7574
Mailing Address - Country:US
Mailing Address - Phone:612-772-8031
Mailing Address - Fax:
Practice Address - Street 1:7570 147TH ST W STE 120
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7574
Practice Address - Country:US
Practice Address - Phone:612-772-8031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician