Healthcare Provider Details

I. General information

NPI: 1063339083
Provider Name (Legal Business Name): HABSO ABDULLAHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WILSON AVE NE STE 207
SAINT CLOUD MN
56304-0418
US

IV. Provider business mailing address

22 WILSON AVE NE STE 207
SAINT CLOUD MN
56304-0418
US

V. Phone/Fax

Practice location:
  • Phone: 320-428-5043
  • Fax: 320-968-1280
Mailing address:
  • Phone: 320-428-5043
  • Fax: 320-968-1280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: