Provider Demographics
NPI:1750929998
Name:IMRAN, AALIYAH RAHEEMAH
Entity type:Individual
Prefix:
First Name:AALIYAH
Middle Name:RAHEEMAH
Last Name:IMRAN
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 1:4211 20TH LN NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-3730
Mailing Address - Country:US
Mailing Address - Phone:360-704-8614
Mailing Address - Fax:
Practice Address - Street 1:4211 20TH LN NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-3730
Practice Address - Country:US
Practice Address - Phone:360-704-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician