Healthcare Provider Details

I. General information

NPI: 1669376711
Provider Name (Legal Business Name): FATIMA ALI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 VIKING DR
EDEN PRAIRIE MN
55344-7207
US

IV. Provider business mailing address

1112 KENNSINGTON DR
SHAKOPEE MN
55379-3517
US

V. Phone/Fax

Practice location:
  • Phone: 612-416-1301
  • Fax:
Mailing address:
  • Phone: 507-400-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: