Healthcare Provider Details

I. General information

NPI: 1073431748
Provider Name (Legal Business Name): HIKMAT MAGASSA AYANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 5TH AVE S
SOUTH SAINT PAUL MN
55075-3453
US

IV. Provider business mailing address

1547 5TH AVE S
SOUTH SAINT PAUL MN
55075-3453
US

V. Phone/Fax

Practice location:
  • Phone: 952-688-3099
  • Fax: 651-207-6128
Mailing address:
  • Phone: 952-688-3099
  • Fax: 651-207-6128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: