MEDICARE: SADIYA HUSSEIN HAILLE

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
1	106S00000X	Behavior Technician		MN

General Provider Information

NPI Number	:	1245026467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SADIYA HUSSEIN HAILLE

Provider Business Mailing Address
First Line	:	1901 W 80 1/2 ST UNIT 102
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55431-5107
Country	:	US
Telephone Number	:	612-438-7661
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 INDUSTRIAL DR S STE 109
Second Line	:
City	:	SAUK RAPIDS
State	:	MN
Zip	:	56379-1271
Country	:	US
Telephone Number	:	612-438-7661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	04/15/2025

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