Provider Demographics
NPI:1740973049
Name:GESAADE, RUKIA LIBAN
Entity type:Individual
Prefix:
First Name:RUKIA
Middle Name:LIBAN
Last Name:GESAADE
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 1:4807 WINGARD PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1212
Mailing Address - Country:US
Mailing Address - Phone:952-649-0652
Mailing Address - Fax:
Practice Address - Street 1:1919 BROADWAY ST NE STE 120
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1253
Practice Address - Country:US
Practice Address - Phone:612-323-1871
Practice Address - Fax:612-656-0203
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician