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NPI Code Detail

MEDICARE: FADUMO ALI

MEDICARE: FADUMO ALI
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
1101YA0400XAddiction (Substance Use Disorder) Counselor306343MN
2101YM0800XMental Health Counselor4450MN

General Provider Information

NPI Number : 1134862840
Entity Type Code : Individual
Provider Name (Legal Business Name) : FADUMO ALI
Provider Business Mailing Address
First Line : 2424 12TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3808
Country : US
Telephone Number : 763-742-9250
Fax Number :
Provider Business Practice Location Address
First Line : 2118 BLAISDELL AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-2415
Country : US
Telephone Number : 763-742-9250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2022
Last Update Date : 06/01/2026

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Directions to “ FADUMO ALI ” Practice Location

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