Healthcare Provider Details

I. General information

NPI: 1316880081
Provider Name (Legal Business Name): HODAN MOHAMED HASSAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 UNIVERSITY AVE NE
MINNEAPOLIS MN
55432-3134
US

IV. Provider business mailing address

3500 E LAKE ST
MINNEAPOLIS MN
55406-2151
US

V. Phone/Fax

Practice location:
  • Phone: 612-208-0729
  • Fax: 612-354-3801
Mailing address:
  • Phone: 612-298-2169
  • 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: