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General NPI Number Information
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NPI Number | 1467328872
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Entity Type | Individual
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Provider Name | ABDIYA MOHAMED ISMAIL
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Gender | Female
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 1821 UNIVERSITY AVE W STE 169
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City | SAINT PAUL
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State | MN
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Zip | 55104-2803
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Country | US
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Telephone | 612-442-0073
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Fax |
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Provider Business Mailing Address
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Address Line | 6157 134TH ST W
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City | APPLE VALLEY
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State | MN
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Zip | 55124-8108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | MN
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