Healthcare Provider Details

I. General information

NPI: 1619880523
Provider Name (Legal Business Name): FATUMA ABDI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 PENNOCK AVE
SAVAGE MN
55378
US

IV. Provider business mailing address

1450 PENNOCK AVE SUITE 102
SAVAGE MN
55378
US

V. Phone/Fax

Practice location:
  • Phone: 612-819-5205
  • Fax:
Mailing address:
  • Phone: 612-819-5205
  • Fax: 161-232-9001

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: