Provider Demographics
NPI:1770327744
Name:JAMA, AYAN AHMED
Entity type:Individual
Prefix:
First Name:AYAN
Middle Name:AHMED
Last Name:JAMA
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 1:9700 WATERSTONE PL APT 116
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-7501
Mailing Address - Country:US
Mailing Address - Phone:651-278-7319
Mailing Address - Fax:
Practice Address - Street 1:1627 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-1609
Practice Address - Country:US
Practice Address - Phone:651-278-7319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician