Provider Demographics
NPI:1982465357
Name:ISSE, SIHAM ABDIRIZAK
Entity Type:Individual
Prefix:
First Name:SIHAM
Middle Name:ABDIRIZAK
Last Name:ISSE
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 1:2431 119TH CT NE UNIT B
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4860
Mailing Address - Country:US
Mailing Address - Phone:651-348-9913
Mailing Address - Fax:612-354-3801
Practice Address - Street 1:7205 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3134
Practice Address - Country:US
Practice Address - Phone:161-229-8763
Practice Address - Fax:612-354-3801
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician