Provider Demographics
NPI:1912758418
Name:JUMALE, ILHAM AHMED
Entity Type:Individual
Prefix:
First Name:ILHAM
Middle Name:AHMED
Last Name:JUMALE
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 1:2930 BLAISDELL AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2327
Mailing Address - Country:US
Mailing Address - Phone:717-590-0604
Mailing Address - Fax:612-395-3315
Practice Address - Street 1:2930 BLAISDELL AVE APT 307
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2327
Practice Address - Country:US
Practice Address - Phone:717-590-0604
Practice Address - Fax:612-395-3315
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician