Provider Demographics
NPI:1780457069
Name:ABDULLE, AISHA WALI
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:WALI
Last Name:ABDULLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AISHA
Other - Middle Name:WALI
Other - Last Name:ABDULLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1117 MARQUETTE AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2447
Mailing Address - Country:US
Mailing Address - Phone:651-233-9868
Mailing Address - Fax:
Practice Address - Street 1:1117 MARQUETTE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2447
Practice Address - Country:US
Practice Address - Phone:651-233-9868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician