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NPI Code Detail

MEDICARE: ABDIRAHMAN ABDIRASHID IBRAHIM

MEDICARE: ABDIRAHMAN ABDIRASHID IBRAHIM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMN

General Provider Information

NPI Number : 1003766122
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABDIRAHMAN ABDIRASHID IBRAHIM
Provider Business Mailing Address
First Line : 2001 KILLEBREW DR STE 112
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-1871
Country : US
Telephone Number :
Fax Number : 612-326-6160
Provider Business Practice Location Address
First Line : 2720 SUPERIOR DR NW STE 101
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-1775
Country : US
Telephone Number : 507-208-4007
Fax Number : 612-326-6160
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2026
Last Update Date : 01/29/2026

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