Provider Demographics
NPI:1740004704
Name:ADAN, ASHKIRO
Entity type:Individual
Prefix:
First Name:ASHKIRO
Middle Name:
Last Name:ADAN
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 1:74 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1055
Mailing Address - Country:US
Mailing Address - Phone:612-636-5139
Mailing Address - Fax:612-465-5056
Practice Address - Street 1:74 10TH AVE S
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1055
Practice Address - Country:US
Practice Address - Phone:612-636-5139
Practice Address - Fax:612-465-5056
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst