Healthcare Provider Details

I. General information

NPI: 1205686961
Provider Name (Legal Business Name): HASHIM ABDULLAHI AIDEED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 28TH AVE N
SAINT CLOUD MN
56303-4640
US

IV. Provider business mailing address

37 28TH AVE N
SAINT CLOUD MN
56303-4640
US

V. Phone/Fax

Practice location:
  • Phone: 612-814-3567
  • Fax:
Mailing address:
  • Phone: 612-814-3567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: