Provider Demographics
NPI:1659102325
Name:HASSAN, HODA AHMED
Entity type:Individual
Prefix:
First Name:HODA
Middle Name:AHMED
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 1:5769 EGAN DR
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-4917
Mailing Address - Country:US
Mailing Address - Phone:952-214-1124
Mailing Address - Fax:952-800-0161
Practice Address - Street 1:5769 EGAN DR
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-4917
Practice Address - Country:US
Practice Address - Phone:952-214-1124
Practice Address - Fax:952-800-0160
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician