Healthcare Provider Details

I. General information

NPI: 1538092887
Provider Name (Legal Business Name): ABDIRAHMAN HAJJI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 10TH AVE S
WAITE PARK MN
56387-1055
US

IV. Provider business mailing address

1615 7TH ST SE
SAINT CLOUD MN
56304-1357
US

V. Phone/Fax

Practice location:
  • Phone: 612-636-5139
  • Fax: 612-465-5056
Mailing address:
  • Phone:
  • Fax:

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: