Healthcare Provider Details

I. General information

NPI: 1528719978
Provider Name (Legal Business Name): MARYAN I HUSSEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 BROADWAY ST NE
MINNEAPOLIS MN
55413-2617
US

IV. Provider business mailing address

1600 BROADWAY ST NE
MINNEAPOLIS MN
55413-2617
US

V. Phone/Fax

Practice location:
  • Phone: 612-412-3318
  • Fax: 612-288-1805
Mailing address:
  • Phone: 612-412-3318
  • Fax: 612-288-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33992
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: