Healthcare Provider Details

I. General information

NPI: 1003739293
Provider Name (Legal Business Name): JANNAH HASSAN MOHAMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROOK AVE SE APT 306
MINNEAPOLIS MN
55414-2689
US

IV. Provider business mailing address

1201 BROOK AVE SE APT 306
MINNEAPOLIS MN
55414-2689
US

V. Phone/Fax

Practice location:
  • Phone: 651-666-1267
  • Fax: 651-666-1268
Mailing address:
  • Phone: 651-666-1267
  • Fax: 651-666-1268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: