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NPI Code Detail

MEDICARE: DEQO MOHAMED AHMED MSW, LICSW

MEDICARE: DEQO MOHAMED AHMED MSW, LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker26109MN

General Provider Information

NPI Number : 1336867399
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEQO MOHAMED AHMED MSW, LICSW
Provider Business Mailing Address
First Line : 5275 EDINA INDUSTRIAL BLVD STE 228
Second Line :
City : EDINA
State : MN
Zip : 55439-2920
Country : US
Telephone Number : 952-688-6792
Fax Number :
Provider Business Practice Location Address
First Line : 11010 PRAIRIE LAKES DR STE 350
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-3801
Country : US
Telephone Number : 952-746-2522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2022
Last Update Date : 01/06/2026

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