Healthcare Provider Details

I. General information

NPI: 1770411159
Provider Name (Legal Business Name): HAFSA HUSSEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 UNIVERSITY AVE W STE 261-5
SAINT PAUL MN
55104-2928
US

IV. Provider business mailing address

1821 UNIVERSITY AVE W STE 261-5
SAINT PAUL MN
55104-2928
US

V. Phone/Fax

Practice location:
  • Phone: 612-481-6172
  • Fax: 612-481-6172
Mailing address:
  • Phone: 612-481-6172
  • Fax: 612-481-6172

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: