Provider Demographics
NPI:1649019787
Name:BASHIR, ROWDA MADAD
Entity type:Individual
Prefix:
First Name:ROWDA
Middle Name:MADAD
Last Name:BASHIR
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 1:2233 UNIVERSITY AVE W STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1629
Mailing Address - Country:US
Mailing Address - Phone:651-502-2945
Mailing Address - Fax:612-230-5364
Practice Address - Street 1:2233 UNIVERSITY AVE W STE 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1629
Practice Address - Country:US
Practice Address - Phone:651-502-2945
Practice Address - Fax:612-230-5364
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent