Provider Demographics
NPI:1750913687
Name:ABDIKARANI, KALTUN (LSW)
Entity type:Individual
Prefix:
First Name:KALTUN
Middle Name:
Last Name:ABDIKARANI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 10TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-7606
Mailing Address - Country:US
Mailing Address - Phone:614-460-0045
Mailing Address - Fax:
Practice Address - Street 1:584 10TH AVE SW
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-7606
Practice Address - Country:US
Practice Address - Phone:614-460-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23925104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker